Whistleblower Uncovers Alleged Medicare Sleep Fraud

June 16, 2011

On June 14, 2011, a federal Complaint was filed in U.S. District Court for the Middle District of Florida under the False Claims Act (FCA) against Bay Area Sleep Associates LLC, dba SomnoMedics LLC, and its owner, Edward Killmer Jr.

NOTE: The charges contained in the Complaint are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

The Complaint alleges that by 2004, the defendants had begun to hire unlicensed sleep technicians to perform sleep tests on Medicare and TRICARE  (the health care program serving Uniformed Service members, retirees and their families worldwide) beneficiaries.  However, Medicare regulations required that reimbursable diagnostic testing services performed at such independent diagnostic testing facilities must be performed by a technician licensed or certified by a state or national credentialing body. Despite being fully aware that SomnoMedics failed to comply with the reimbursement regulations, the Complaint alleges that the defendants nonetheless violated the FCA by knowingly submitting, or causing to be submitted, to the United States false claims for payments from multiple federal health care programs.

This lawsuit was originally filed under the qui tam or whistleblower provisions of the FCA by former sleep study technician William Revels, who is referred to as a "Relator," under the FCA. A Relator is a private citizen who can file an action on behalf of the United States and receive a portion of the recovery. In May 2011, the United States intervened in part of the lawsuit, and today filed its own complaint. Under the FCA, the United States may recover three times the amount of its losses plus civil penalties.

Since January 2009, the Justice Department contends that it has utilzed the FCA to recover more than $5.8 billion in cases involving fraud against federal health care programs (total FCA recoveries for that same period are estimated at $7.4 billion).

For a comprehensive discussion of the FCA, see this article on the Department of Justice's website