Whistleblower Lawsuit: American Sleep Medicine to Resolve Medicare Fraud Case for $15M

American Sleep Medicine LLC has agreed to pay a $15,301,341 settlement over claims that it wrongly billed the government for sleep diagnostic services that did not meet eligibility requirements for payment. Daniel Purnell is the one who filed the Florida whistleblower lawsuit under the False Claims Act.

Purnell accused the defendant of submitting false claims to the Railroad Retirement Medicare Program, Medicare, and TRICARE for payments they weren’t eligible for because the services were rendered by technicians that didn’t have the requisite credentials and certifications. The claims allegedly occurred between 2004 through 2011. Because the False Claim Act allows the person that files a Qui Tam case to potentially be entitled to a percentage of what is recovered on the government’s behalf, Purnell is getting $2.6M.

American Sleep, which is based in Florida, is the owner/operator of 19 diagnostic sleep testing centers in numerous states. The company offers testing to patients who have sleep disorders so that doctors can use the findings to figure out the appropriate treatments.

One common diagnosis tool is a procedure named polysomnographic diagnostic sleep testing. Per federal program requirements, for reimbursement claims, sleep disorder testing has to be done by technicians that are licensed or certified as sleep test technicians by national/state credentialing bodies.

Under the federal False Claims Act, citizen whistleblowers can perform a service for the government by reporting fraud involving a party seeking payment for false claims. Depending on how much is recovered on the government’s behalf, a whistleblower may be entitled to up to 30% of the award.

You want to work with a whistleblower law firm that has a clear understanding of how this type of case works and knows not only how to pursue a successful claim for you but also can protect your rights, and in some cases, perhaps even your job—especially if you are suing your employer for fraud against the government. Unfortunately, retaliation by employers can happen.

Common whistleblower claims may involve:

  • Medicare/Medicaid fraud-related cases involving health care providers
  • Pharmaceutical fraud
  • Securities fraud
  • Over-billing the federal government for actual services rendered
  • Insider trading
  • IRS-related fraud
  • Government contractor abuse related to contracts for women, minorities, and veterans through the set up of straw-man corporate entities that don’t include minorities.

Among the legal requirements that must be met to file a whistleblower lawsuit:

  • The fraud allegations can’t have already been previously disclosed in a government report or to the media. (Also important to know, is the claimant the first whistleblower to bring the fraud information to the government?)
  • The fraud must have been committed against a government entity that allows whistleblower claims.
  • The whistleblower case has to be submitted within six years of the fraud occurring (in certain cases a ten year-limitations statute may exist).
  • The whistleblower cannot belong to the Armed Forces or make a claim against another member.
  • The defendant of a whistleblower cases cannot be a Congress member or an official of a senior executive or judiciary branch.

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