American Sleep Medicine Settlement: The Staffing Behind the Bill

American Sleep Medicine LLC paid $15,301,341 in a settlement over allegations that technicians performing federally billed sleep tests lacked required qualifications. The case turns on a connection a sleep-lab insider may recognize: the person assigned to a test, the qualifications required for that work and the claim sent for payment. If you knew the staffing behind the studies, your view of the business may reach further than the finished report.

The Justice Department announced the settlement on January 3, 2013. At the time, American Sleep Medicine operated 19 diagnostic centers in 14 states, with headquarters in Jacksonville, Florida.

What Was the American Sleep Medicine Settlement?

The American Sleep Medicine settlement resolved allegations that the company submitted claims for sleep diagnostic testing performed by technicians who lacked required licenses, certifications or credentials. The signed agreement identifies Medicare Part B, TRICARE and the Railroad Retirement Medicare Program as the public payers. Its covered period concerns claims submitted from January 1, 2004 through December 31, 2011.

The agreement excludes claims submitted by the Rancho Cucamonga Sleep Lab beginning on or after October 4, 2007. For an insider who worked at a particular location, the site and claim date are part of the story, even when the same company name appears across the business.

A former employee brought the False Claims Act qui tam case. The Department of Health and Human Services Office of Inspector General investigated, with assistance from the FBI, the Defense Criminal Investigative Service and the Railroad Retirement Board Office of Inspector General.

Why Technician Qualifications Mattered to the Claim

A technician’s work is part of the diagnostic service the payer buys. Sleep testing involves acquiring and monitoring signals, documenting the study, scoring the recording and obtaining a physician’s interpretation. Those jobs can involve different people, and the billing provider submits a claim describing the service performed.

That division of work gives the qualification allegation its force. The physician’s report reaches the end of a process that began with someone operating the test and documenting what happened. The staffing assignment and qualification history concern that earlier work, while the claim connects it to public money. A reader who works on scheduling, technical performance or billing may see a different part of the same test.

In American Sleep Medicine’s case, the Justice Department alleged that tests were performed by technicians who lacked the qualifications the programs required. The person who knew the overnight assignments could see something the payment paperwork alone would not explain. We call that billing past the qualifications.

Must Every Sleep Technician Hold the Same Credential?

No. The applicable qualification pathway depends on the worker’s role, state authorization, facility setting and payer policy. A technician’s credential, the facility’s accreditation and its Medicare enrollment describe different parts of the service. We connect those records to the actual person and test.

First Coast’s polysomnography and sleep-testing policy illustrates the alternatives. The version effective July 1, 2020 lists several accepted credentials and allows specified unregistered personnel affiliated with an accredited sleep facility, subject to training and supervision requirements. It requires supervision by a registered technologist, licensed where state law requires a license. This policy took effect after the claims covered by American Sleep Medicine’s settlement. For that case, the agreement names the historical Medicare and TRICARE requirements behind the allegations.

Physician supervision is another question again. It concerns the physician’s direction and oversight of the service, while technician qualifications concern the person performing the technical work. Keeping those roles separate helps us identify which part of a sleep-testing claim an insider’s knowledge actually explains.

The Whistleblower Share and the Government’s Recovery

The agreement assigned the former employee a whistleblower share of 17% of each settlement payment the United States received. The Justice Department reported the share as about $2.6 million.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In this case, a former employee’s allegations connected technician qualifications to claims across federal health care programs. We work with insiders to develop that connection between what they saw in the business and the public money at issue.

American Sleep Medicine also entered a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General, including internal monitoring and independent review. The settlement barred the company from charging its settlement payments and specified investigation, defense and review costs to government programs or contracts. Taxpayers were not supposed to get the bill for resolving the allegations.

Millennium Shows Why the Person and the Facility Both Matter

Millennium Physicians Association’s sleep-testing settlement shows how personnel qualifications and facility accreditation can arise separately in the same case. In its March 11, 2020 announcement, the Justice Department described an employee’s allegation that studies were conducted without properly credentialed technicians. It also described a separate company self-report that its two facilities lacked required accreditation or certification.

The two covered different periods. Who performed the test and whether the location met its requirements are different records to examine against the claim for payment.

What the Staffing Records Can Show

The useful connection runs from the person and place to the study and the claim. A test date, technician assignment and qualification history can show who performed the work and what credentials were in effect. The order, recording, scoring record and physician interpretation describe the diagnostic service that reached billing.

If your work put you on the testing floor, you may know how assignments were made and who actually performed a study. If you worked with credentials or claims, you may know whether the personnel records and the billing account tell the same story. Those are different views of the business, and each can help explain a healthcare claim that looks routine from outside.

You Know Who Performed the Study

If you saw a gap between technician qualifications and the sleep studies billed to federal programs, speak to one of our Whistleblower Experts about the people, dates and claims you know. We build the case with you and bring in healthcare fraud whistleblower lawyers who understand diagnostic testing and public-payer billing. We stay beside you to turn your knowledge of the lab into your strongest sleep testing whistleblower case.