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Sleep Health Center Billed Medicare for Some Unallowable Sleep Study Services

Sleep Health Center (Sleep Health), based in Fort Myers, Florida, billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries that we reviewed, Sleep Health billed Medicare claims for polysomnography services that met Medicare billing requirements for 36 beneficiaries with 137 corresponding lines of service. However, Sleep Health billed Medicare claims for the remaining 64 beneficiaries with 149 corresponding lines of service that did not meet Medicare requirements, resulting in overpayments totaling $49,000. These errors occurred primarily because Sleep Health did not have adequate controls to ensure that it properly documented polysomnography services billed to Medicare. On the basis of our sample results, we estimated that Sleep Health received overpayments of at least $487,000 for the audit period.

Filed under: Center for Medicare and Medicaid Services