sleep lab busted by medicare

Sleep Lab Busted by Medicare

Sleep Review magazine reports that HMS Diagnostics Inc was recently

busted by CMS (Medicare) for having uncertified technicians run sleep

studies on Medicare patients:

Sleep Lab Medicare Claims Under Investigation

Accredited Sleep Disorder Center HMS Diagnostics Inc reports that it

has been the focus of an investigation by the US Department of Health

and Human Services (HHS), Office of Inspector General (OIG), and the

Federal Bureau of Investigation. Using what the company calls "a

requirement little known in the sleep diagnostics industry," the US

Attorney's Office is suggesting HMS Diagnostics Inc may have

improperly billed certain CPT codes for sleep tests that Medicare

should not have reimbursed and is seeking a large settlement.

According to the company, the US Attorney's Office in conjunction with

the HHS, the OIG, and the FBI, conducted a 10-month investigation of

HMS Diagnostics Inc. They have concluded that HMS Diagnostics Inc may

have improperly billed certain CPT codes for sleep tests that Medicare

should not have reimbursed. They stated that they believe submission

of those claims violated the False Claims Act, stating that the

technicians did not have the required certifications for billing CPT

98510 and CPT 98511 (42.CFR 410.33 c), HMS Diagnostics Inc says. The

claims that are being called a violation go back as far as January 1,

2002, and potentially involve substantial penalties.

John Goodman, president of HMS Diagnostics Inc, feels strongly that

very few people in the industry today are aware of this potentially

very serious situation. "We believe that the majority of labs think

the tech certification rules only just recently went into place, ie,

as of October 1, 2007. But in fact, according to CMS, the regulation

was actually published and effective since at least 2002." However,

from Goodman's perspective, he says, "My research indicates that these

regs were never spotlighted or otherwise highly advertised by the

government, which seems unbelievably unfair to us and everyone else in

the sleep industry."

The company says that its practices are consistent with those of other

accredited sleep centers that operated under the belief that certified

technicians were required to directly attend each patient as of

October 1, 2007 (not before this date). Upon receiving the result of

the investigation, HMS Diagnostics Inc says it has found numerous

articles about this requirement with dates as varied as February 26,

2007, October 1, 2007, and, January 1, 2008. The release claims that

date confusion and conflict are apparent and widespread in the

literature, legal opinions, and the regulations themselves.

There is also a requirement that states, "If a technician leaves the

company, if a new technician is hired or when a technician's license

expires and he obtains a renewal, the IDTF must provide this

information to the carrier on an amended 855B with attachment II.

Failure to do so may result in suspension of its Medicare provider

number."

According to the release, the US Attorney's Office seems to be

suggesting that any CPT 98510 or CPT 98511 study not actually

performed by a credentialed technician cannot be billed. The fact that

the credentialed technician is on site and supervising apparently is

not a factor, HMS Diagnostics stated in the release.

HMS Diagnostics Inc seeks to inform other well-intended diagnostic

facilities to pay extremely close attention to the potential pitfalls

that have been created by government regulations and their

interpretation by the government. "If what CMS is saying is true, then

the amount of money that would be owed to Medicare by the industry is

phenomenal," says Goodman. "The liability potential on an industry

such as ours with Medicare could be a very big number."

This is a disturbing development. The requirement for tech

certification is virtually unknown in the sleep community. On the AASM

message boards, we were recently discussing a new CMS regulation that

All studies are to be done by a certified polysomnographer by January

1, 2008 in Arkansas, Louisiana, Eastern Missouri, New Mexico, and

Oklahoma and by October 1, 2008 in Rhode Island; and the consensus was

that uncertified technicians were ok for the time being in most other

states. Most sleep labs have a combination of certified and

uncertified techs, and I agree with the article that if CMS is going

to enforce this newly discovered regulation, the amount of money owed