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Catch of the Week: Fraudulent Sleep Tests in Fresno

Posted  October 29, 2021

Fraud permeates through all aspects of America’s healthcare system- from hospitals to big pharma to chiropractors. This week’s catch of the week focuses on another part of the system, sleep clinics. As increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders, the significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous to engage in fraudulent services and billing, exactly what this week’s fraudster is accused of doing.

Travis Gober, who owns and operates a sleep clinic in Central Valley, has been criminally indicted for over $10 million of Medicare fraud. Medicare covers medically necessary diagnostic testing for sleep disorders, with necessity being defined by symptoms of diseases such as narcolepsy, sleep apnea, impotence, or parasomnia. To get paid by Medicare, sleep clinics need to meet certain criteria: the clinic must be either affiliated with a hospital or is under the direction and control of a physician; patients are referred to the sleep disorder clinic by their attending physician, and the clinic maintains a record of the attending physician’s orders; and medical evidence such as physician examinations confirm the need for diagnostic testing.

Gober’s clinic is alleged to have violated many of these requirements and instead committed a litany of frauds including billing Medicare for services the clinic never performed, including services associated with deceased Medicare beneficiaries, and services that the clinic billed for after it went out of business and ceased operations. The clinic also allegedly used physician referrals as justifications for diagnostic testing without those physicians having any knowledge of these referrals.

The government alleges the clinic of fraudulently billing for over 800 patient encounters leading to over $10 million in Medicare spending. If convicted, Gober faces a maximum of 10 years in prison and restitution payments. This is not the first sleep clinic settlement. A Constantine Cannon client blew the whistle and led to a $2.6 million government recovery in 2017, and a sleep apnea device manufacturer paid over $37 million to resolve kickback allegations in 2020. It certainly will not be the last- taxpayer dollars are at risk, and whistleblower vigilance will be essential to safeguard that money.

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Tagged in: Catch of the Week, Healthcare Fraud, Improper Medical Facility, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Medical Devices and DME, Medicare, Provider Fraud,