Losing Sleep

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A lot of things can make you lose sleep. Perhaps you think too much about your ”to do” list or maybe your significant other snores. There could also be a medical reason behind your inability to get enough rest. Whatever the case, sleep clinics exist to determine the underlying cause. The owners and operators of a sleep clinic chain in California now owes the government $2.6 million to settle allegations that they broke a few rules by fraudulently billing Medicare. (Owing that amount of money would definitely make me lose some sleep.)

The owners of the sleep clinic chain, who were enrolled with Medicare as approved providers, broke a couple of rules required by the government health care program. A whistleblower filed a complaint under the False Claims Act causing investigators to look into several allegations.

Apparently, the business did not employ sleep clinic technicians with the proper licenses and certificates required by Medicare. (That’s kind of creepy thinking that unqualified medical personnel are watching you sleep. That could definitely skew some test results.) In addition, the sleep tests were allegedly completed at unapproved locations although the owners and operators falsified documents to make it look like the tests had been completed at two approved locations. And last but not least, Medicare was billed for medical devices despite the fact that sleep test providers are prohibited from supplying medical devices and sharing a sleep lab with a durable medical equipment supplier.

The sleep clinic chain owners and operators, both 58, volunteered to terminate their agreements as providers under Medicare and agreed not to re-enroll for three years. The person who placed the complaint will receive $545,000 from the $2.6 million settlement for providing the government with information about the company’s fraudulent acts. (It’s a good guess that the whistleblower will be sleeping pretty soundly after she cashes that big check.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Saratoga: Bay Sleep Clinic owners to pay $2.6M to settle Medicare fraud allegations,” published by the Mercury News on December 28, 2016.

SARATOGA – The owners and operators of a sleep clinic chain have agreed to pay $2.6 million to settle allegations that they fraudulently billed Medicare, according to the U.S. Attorney’s Office.

As early as April 2002, Anooshiravan Mostowfipour and Tara Nader, both 58 and of Saratoga, billed Medicare for sleep tests performed by Bay Sleep Clinic technicians who lacked the proper licenses and certificates, according to a False Claims Act complaint filed in August.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.