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Total Sleep Management, Inc., Billed Medicare for Unallowable Sleep Study Services

Total Sleep Management, Inc. (Total Sleep), an Independent Diagnostic Testing Facility, based in Orlando, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries, Total Sleep billed Medicare claims for polysomnography services that met Medicare billing requirements for 21 beneficiaries with 38 corresponding lines of service. However, Total Sleep billed Medicare claims for the remaining 79 beneficiaries with 111 corresponding lines of service that did not meet Medicare requirements, resulting in overpayments totaling $51,000.

On the basis of our sample results, we estimated that Total Sleep received overpayments of at least $1 million for the audit period. This overpayment amount includes claim payment dates outside of the 3-year recovery period. Of the total estimated overpayments, at least $423,008 was within the 3-year recovery period. These errors occurred primarily because Total Sleep did not have adequate controls to ensure that it properly documented polysomnography services billed to Medicare and that its attending technicians had the proper certification.

Filed under: Center for Medicare and Medicaid Services