Joseph Krainin, founder and president of Singular Sleep, a provider of home sleep tests. (See the article “ How the Medicare CPAP Payment Prohibition Affects Your Business” at this link for more information.)Ī home test for sleep apnea should meet the American Academy of Sleep Medicine’s (AASM) SCOPER guidelines (or Sleep, Cardiovascular, Oximetry, Position, Effort and Respiratory), said Dr. It’s important for home medical equipment (HME) providers to note that if they provide the HST to Medicare patients, Medicare will not reimburse if they provide the same patient with a CPAP. A physician orders the test, which is shipped to the patient’s home by a provider. Sleep ApneaĪn at-home sleep test is often prescribed when a patient is suspected to have sleep apnea. Home sleep testing (HST) may hold the answer, at least for obstructive sleep apnea and some types of insomnia. ![]() But what if they are sleeping enough hours-but still feel tired in the morning? Sleep disorders, including obstructive sleep apnea (OSA), restless leg syndrome, circadian rhythm disorders and parasomnias can lead to feeling unrested the next morning-not to mention the disruption to bed partners’ sleep patterns. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at or at, under case number 19-cv-61084.Usually, people know when they have problems getting enough sleep. Assistant United States Attorneys Jessica R. The whistleblower share to be awarded in connection with the settlement is $630,000.00. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. This matter arose from a lawsuit filed by Amber Watt in federal court in Miami, Florida. “HHS-OIG will continue to investigate such actions to ensure the efficiency and integrity of these programs.” “By submitting false claims to Medicare, providers waste valuable taxpayer dollars and undermine the integrity of federal health care programs,” said Special Agent in Charge Omar Pérez Aybar, at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “My Office will continue to hold accountable those health care providers who manipulate the system to benefit their own bottom line.” “The fraudulent billing of Medicare results in systemically higher medical care costs for all,” said United States Attorney Gonzalez. ![]() Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced the settlement. Juan Antonio Gonzalez, United States Attorney for the Southern District of Florida, and Omar Pérez Aybar, Special Agent in Charge, U.S. The five-year CIA requires, among other things, that VirtuOx retain an outside expert to perform annual claims reviews that address the place of service identified on the claim. Department of Health and Human Services, Office of Inspector General (HHS-OIG). Accordingly, the United States alleged that VirtuOx knowingly submitted false claims by separately billing for both an oxygen “spot check” and an overnight pulse oximetry test when only an overnight pulse oximetry test was performed.Ĭontemporaneous with the civil settlement, VirtuOx entered into a Corporate Integrity Agreement (CIA) with the U.S. In particular, the United States alleged that, because an awake reading is necessarily taken as part of an overnight pulse oximetry test, the separate billing of a “spot check” is redundant and generally not necessary. The United States further alleged that, from January 2016 to December 2020, VirtuOx administered overnight pulse oximetry tests and, at times, also billed Medicare for single determination pulse oximetry tests (commonly referred to as an oxygen “spot check”) for the same patient when in fact the only test performed was the overnight test. ![]() In particular, the United States alleged that, in connection with its billing for overnight pulse oximetry claims, VirtuOx knowingly submitted false claims to Medicare identifying its IDTF located in San Francisco, California as the location of service for overnight pulse oximetry tests when, in fact, no services were performed at that location in relation to the overnight oximetry claims. The United States alleged that, from January 2016 to December 2020, VirtuOx violated the False Claims Act by falsely identifying the place of service for certain services it performed to obtain a higher rate of reimbursement from Medicare. (“VirtuOx”), based in Coral Springs, Florida and operating Medicare approved Independent Diagnostic Testing Facilities (“IDTF”), has agreed to pay $3,150,000.00 to resolve allegations that it submitted or caused to be submitted false claims to Medicare for reimbursement.
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