Sleep disorder medical practice with clinics in California and Washington resolves allegations it overbilled government medical programs

Seattle – The Department of Justice and Innovative Sleep Centers PLLC and Innovative Sleep Centers, Inc., have resolved allegations that the sleep centers improperly billed Medicare and Medicaid for medical services. The clinics paid $644,562 to resolve the matter. Of the settlement amount, $435,404 went to the federal government as restitution and penalties and $209,138 to Washington State for its share of restitution and penalties. 

The United States contends that between 2013 and 2022, Innovative Sleep Centers (ISC) submitted three categories of false claims for payment to Medicare and Medicaid.

• Between January 2018 and December 2020, ISC submitted false claims to Medicare for evaluation and management (E&M) services that were performed by lower-level providers, but billed under the name of ISC’s Medical Director, Dr. Mehrdad Razavi. By identifying a physician as the rendering provider on the claims, the clinic was able to bill at a higher rate. Those bills were false.
• Between October 2013 and July 2022, ISC submitted claims to Medicare for office visits that falsely identified Dr. Razavi as the rendering provider. In fact, the services were provided by employees who were not qualified to perform office visits, including office staff, Respiratory Therapists, and Registered Polysomnographic Technologists. By billing the claims under a physician’s NPI, ISC obtained reimbursement for non-covered services.
• And finally, between January 2015 and December 2020, ISC submitted false claims to Medicare and Medicaid for sleep studies that were performed by technologists who did not have required credentials.

The claims resolved by the settlement are allegations only and there has been no determination of liability.

The settlement resolved a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties known as relators to file suit on behalf of the government for false claims and to share in any recovery. The qui tam suit is captioned United States, State of California and State of Washington ex rel. SW Sleep LLC v. Innovative Sleep Centers, PLLC et al., No. 3:19-CV-5604 (W.D. Wash.).

The matter was handled by Assistant United States Attorneys Ashley Burns and Kayla Stahman and investigated by the Office of the Inspector General for the Department of Health and Human Services (HHS-OIG).