Millennium Physicians Association Sleep Study Settlement: Sleep Technicians, Accreditation and an Employee Whistleblower

Millennium Physicians Association paid $1,248,964 in a sleep study settlement to resolve allegations that it billed Medicare for tests without required personnel and at unaccredited facilities. An employee raised the staffing problem, and the company separately reported the facility problem. If you worked the shifts, checked credentials or handled accreditation, those are different parts of the testing business you may know firsthand.

Millennium Physicians Association PLLC was based in The Woodlands and operated two Houston-area sleep centers as Millennium Respiratory & Sleep Disorder Specialists. The Justice Department’s March 11, 2020 announcement described the payment and both allegations. This case follows the alleged gap between the people and facilities Medicare required and the testing Millennium billed.

What Did the Employee Allege About Sleep Technicians?

The employee alleged that Millennium conducted sleep studies without properly credentialed technicians present. The Justice Department said the investigation began after the employee filed a whistleblower lawsuit. The U.S. Attorney’s Office for the Southern District of Texas, the Department of Health and Human Services Office of Inspector General and the FBI conducted the investigation.

The staffing allegations covered January 8, 2015 through March 13, 2019. The Justice Department alleged that Millennium billed Medicare and received payment for sleep tests when the required personnel were absent.

For someone working in the sleep center, the connection runs from the actual assignment to the particular study and then to its claim. A staffing schedule identifies who was assigned, credential records establish that person’s qualifications at the time, and the study record ties the work to the test. Together, those records show what the billing entry leaves out: who actually ran the study.

The 2015 Medicare rule for independent diagnostic testing facilities required those facilities to keep documentation showing that testing personnel met its qualification requirements. For an insider responsible for personnel files, that puts the paperwork beside the work: whose qualifications the facility documented, which tests that person performed and when. We examine those connections against the requirements for the particular service, site and date.

What Was the Separate Facility Accreditation Problem?

Millennium self-reported that two sleep-testing facilities lacked the required accreditation or certification from 2011 through 2019. The Justice Department alleged that Millennium knowingly submitted, or caused others to submit, false Medicare claims for studies performed at those centers. Its release named the American Academy of Sleep Medicine, the Joint Commission and the Accreditation Commission for Health Care Inc. as accepted accrediting or certifying bodies.

That facility period reaches further back than the staffing period. The employee’s allegation concerned who was present to perform the test, while the company’s disclosure concerned the testing facilities’ status. A personnel file and an accreditation certificate answer different questions about the same Medicare service.

For a person responsible for accreditation, the useful connection is between the service and location covered by the accreditation and the place where the billed study actually occurred. The service-facility information on the claim lets us compare the billed location with the place you know performed the test. That connects the accreditation history to a specific request for Medicare payment.

The Employee’s Share of the Millennium Recovery

The Justice Department reported that the employee received a share of the settlement recovery. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In Millennium, an employee’s knowledge of who was performing the studies helped bring the staffing issue into an investigation that ended with a payment and an employee share.

Which Records Connect Sleep Center Staffing and Accreditation to Medicare Claims?

The useful evidence connects the person, testing location and service date to what Medicare was billed and paid. For staffing, that means the actual assignment and attendance, the person’s training and credential dates, and the study performed on that shift. For the facility issue, it means the accreditation or certification history, the covered location and service, and the studies billed from that site.

Sleep testing divides work among people with different responsibilities. A treating practitioner orders the study and uses the result in care, a technician acquires and monitors signals, a scorer identifies events, and an interpreting physician reviews the required data and provides the interpretation. The billing provider represents that service to the payer. Knowing which part you worked on helps us connect your account to the requirement and payment at issue.

The diagnostic record supplies the link between the work and the claim. Orders, raw recordings, timestamps and completed reports identify the test, while the claim identifies the represented service and the billing and rendering providers. We examine how those records fit the account of someone who knows the work.

A technician may know who covered a shift, an accreditation employee may know which site a certificate covered, and a billing employee may know how the study reached Medicare. Each sees a different decision inside the health care business. Our work with a whistleblower connects those decisions to the alleged false claim, including what the business knew when it sought payment.

Where Millennium Fits Among Sleep Technician Cases

American Sleep Medicine supplies a close personnel parallel. In that case, the Justice Department alleged that technicians lacked required licenses, certifications or credentials for testing billed to Medicare, TRICARE and Railroad Retirement Medicare.

Apnix Sleep Diagnostics shows a different way a staffing allegation can reach investigators. The Justice Department said a proactive claims-data review identified the company among the area’s highest-paid sleep labs, and investigators had received several complaints. Its allegations concerned Medicare studies administered without required trained or certified personnel.

You Know Who Worked the Study

If you know how a sleep center’s staffing or accreditation differed from what it billed Medicare, talk with our whistleblower experts about the testing you saw. We build the case with you and bring in healthcare fraud whistleblower lawyers who understand diagnostic testing and Medicare payment. We stay beside you as your knowledge of the work becomes the foundation for pursuing the government’s recovery.