As Americans’ waist lines have expanded, so have the number of people battling sleep apnea, a potentially lethal condition where the patient stops breathing during sleep. So-called “Independent Diagnostic Testing Facility” sleep clinics have popped up around the country to help people confront this medical problem.
It is not feasible for the Medicare program, or its contractors, to review the patient files for millions of claims for payment it receives from sleep clinic providers, Medicare must rely upon the providers to comply with the Medicare requirements. This honor system only works when you have honest providers.
In the sleep clinic industry, however, there is mounting concern, both inside and outside of the government, that the exponential growth of IDTF sleep tests is driven solely by provider greed, not patient need. With the knowledge that the government is unable to adequately oversee all IDTF sleep clinic operations, unscrupulous providers may decide to ignore certain regulations. However, the vast majority of these regulations have been promulgated for the sake of Medicare beneficiary safety.
For example, Medicare regulations require personnel performing sleep tests at IDTFs be qualified to do so. Medicare regulations state that such personnel must satisfy specific state licensure requirements. As an example, in California, these technicians must be registered polysomnographic technologists, requiring the technician to meet rigorous requirements and credentialing by the Board of Registered Polysomnographic Technologists.
Unfortunately, unless an IDTF employee steps forward and blows the whistle, the government will not know when an IDTF is using an unlicensed sleep technician. As evidenced by a recent government intervention in False Claims Act qui tam action, the government is very interested in such allegations. The whistleblower reward for such bravery could be substantial.
More information for whistleblowers is located at the Nolan Auerbach & White website.