DOJ Pronounces Settlement With House Well being Providers Firm Over FCA Kickback and Overbilling Allegations | Dorsey & Whitney LLP
The Justice Division just lately introduced that it had settled two civil lawsuits qui tam, or whistleblower, practically $4 million False Claims Act provisions. The lawsuits allege {that a} diagnostics firm in suburban Chicago, SNAP Diagnostics, LLC, which affords house testing for sleep problems, defrauded Medicare and 4 different state well being packages via kickbacks and pointless testing. Since Medicare started offering house sleep testing in 2009, SNAP has obtained practically $9 million from Medicare — practically all of it the results of fraud and kickbacks, the federal government alleges.
As alleged by the federal government, SNAP, its founder Gil Raviv and its vice chairman Stephen Burton have violated the False Claims Act and the Anti-Kickback Statute via varied fraudulent billing practices. Particularly, Raviv allegedly directed SNAP to submit requests for the second and third nights of sufferers’ house sleep exams when the corporate knew they have been medically pointless, since solely a single night time of testing was required to successfully diagnose sure sleep problems.
As well as, the federal government claimed that SNAP’s enterprise mannequin relied on a number of illegal kickback schemes. First, SNAP allegedly paid commissions and bonuses to its gross sales pressure for promoting multi-night exams to distributors, and it gave free at-home sleep exams to medical doctors and their households to encourage referrals.
Second, after the sleep exams have been carried out, SNAP employees allegedly interpreted the outcomes and supplied unsigned experiences to the referring physicians, who in flip would invoice as if the physicians had carried out the skilled service of deciphering the outcomes themselves. This allowed suppliers to “maintain” billing for the skilled part of house sleep testing providers. SNAP deliberately allowed physicians to fraudulently invoice for this service with the intention to enhance referrals and enhance SNAP’s enterprise quantity.
Different allegations towards SNAP embrace the pointless and illegal multiplication of co-payments by federal healthcare recipients, together with Medicare seniors.
The settlement will see SNAP pay $3.5 million, Raviv $300,000 and Burton $125,000, for a complete settlement quantity of $3.925 million.
This is not the primary house healthcare firm to succeed in an settlement with the DOJ in latest months (see our March 8, 2022 weblog) and serves as one other reminder for healthcare corporations of the significance of inner controls and due diligence — particularly on the subject of it to federal It’s a funded therapy.
