Physician’s Group Settles Medicaid False Billing Claim Related to Sleep Studies
A whistleblower complaint triggered the investigation, resulting in a $1.2 million settlement.
Last year, Millennium Physicians Association, PLLC, paid the United States government $1,248,964 to settle a false billing claim related to allegations that the company billed Medicare for studies that were conducted without certified specialists. The case highlights how important it is for healthcare facilities that receive Medicare funding to ensure total compliance.
The Government’s Case
Under current regulations, Medicare will only reimburse a facility for a sleep study if it is performed by a “properly trained and certified sleep technician.” Additionally, Medicare requires qualifying facilities are accredited or certified by the America Academy of Sleep Medicine, the Joint Commission, or the Accreditation Commission for Health Care Inc.
Evidently, back in January, 2018, a whistleblower filed a qui tam lawsuit against Millennium Physicians Association (“Millennium”), claiming that the company was billing Medicare for sleep studies that were being conducted without the presence of properly credentialed technicians. The whistleblower was an employee of Millennium at the time they filed the case.
The qui tam lawsuit prompted a government investigation, which uncovered several compliance issues. First, between 2015 and 2019, Millennium conducted sleep studies without properly credentialed technicians, and then billed Medicare for the studies. Second, Millennium self-reported that two of its facilities were not accredited by the appropriate agencies.
Rather than defend the case, Millennium opted to settle the claims without an admission of guilt, for a total of $1,248,964. The whistleblower, or relator as they are also called, will receive $187,344 for bringing the compliance issue to light.
Qui Tam Lawsuits under the False Claims Act
The False Claims Act is a federal law that holds organizations accountable for defrauding various government-funded programs. The government frequently brings cases under the False Claims Act, especially relating to Medicare fraud. According to the United States Department of Justice, more than $2.2 billion was recovered in settlements and judgments in 2020 alone.
While the government can bring a False Claims Act case against an individual or business, the government is often not in the position to do so because it is unaware of the fraud. Thus, one of the most important aspects of the False Claims Act is the qui tam provision. Under the qui tam provision, a private citizen brings a case in the government’s name. If the government believes the claim has merit, it can intervene, and prosecute the case. However, even if the government does not pick up the case, the whistleblower can proceed on their own. While qui tam lawsuits are often filed by current or former employees of an organization, any private citizen can bring a qui tam lawsuit.
To successfully bring a lawsuit under the False Claims Act, the whistleblower (or the government) must prove:
- the defendant presented a claim for payment to a federally funded U.S. government program;
- the claim was false or fraudulent; and
- The defendant knew that the claim was false or fraudulent or acted with reckless disregard in filing the claim.
Any individual or business who is found to have violated the False Claims Act can be responsible for damages consisting of three-times the amount of the fraudulent item. The government will also assess an additional penalty, which is linked to inflation.
To encourage people to step forward and bring a qui tam lawsuit, if a whistleblower brought the claim, they are entitled to a portion of the proceeds. Typically, the award is between 15 to 30 percent of the proceeds. The award is often greater if the government does not prosecute the case.
The Statute of Limitations in a False Claims Act Case
Under the False Claims Act, a case must be filed within a specific time frame; otherwise, it cannot be heard. Specifically, the government or a whistleblower must file a case:
- Six years from the date of the alleged fraud; or
- Three years from the date that the government knew or should have known about the fraud.
A case can be brought before the latter of these two events. However, neither the government nor a private party can bring a lawsuit after ten years from the date of the alleged fraud.
Contact a False Claims Act Defense Attorney for Immediate Assistance
If you face allegations of healthcare fraud, or any other type of claim under the False Claims Act, Oberheiden, P.C. can help. We have assembled a dedicated team of attorneys to defend those facing these serious cases. Many of our lawyers previously supervised fraudulent claims investigations at the U.S. Attorney’s Office and can provide clients with valuable insights. We know how to defeat even the most persuasive complaint. To learn more, reach out to one of our qui tam defense attorneys today at 1-888-680-1745. You can also reach us through our online form, and an attorney will promptly get in touch with you.
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Dr. Nick Oberheiden, founder of Oberheiden P.C., focuses his litigation practice on white-collar criminal defense, government investigations, SEC & FCPA enforcement, and commercial litigation.