Medicare fraud

Golden Hammer: Medicare asleep at the switch with payments for studies

$17M waste could be a wake-up call

If thinking about wasteful government spending keeps you up at night, Medicare can help — for a scant $17 million.

That’s how much investigators think Medicare officials wasted in 2011, overpaying for sleep studies known as polysomnography.

In fact, investigators at the Health and Human Services Department’s inspector general’s office are worried that Medicare officials were asleep at the wheel and missed obvious signs that hospitals and clinics were billing the government for procedures that never took place.

Some reported patients received two studies per day, an impossibility considering that the procedures require an overnight stay, the inspector general said.

Medicare’s parent office, the Centers for Medicare and Medicaid Services, “could likely have prevented nearly all of these inappropriate payments” with a more rigorous oversight system, investigators said.

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** FILE ** Tom Schatz, President of the Council for Citizens against ... more >

For allowing businesses to sleepwalk away with taxpayer funds, CMS wins this week’s Golden Hammer, a distinction awarded by The Washington Times to examples of fiscal waste, fraud and abuse.

CMS officials agreed that there are problems with the system and said they were studying ways to improve oversight and reduce mistakes and fraud. In the meantime, the agency said it will try to recover the $17 million in overpayments.

In January, the government sued and successfully won a $15.3 million payment from Florida-based American Sleep Medicine LLC over claims that the company was trying to get reimbursed for bogus studies.

“The CMS is committed to preventing improper and fraudulent billing for polysomnography services, particularly given the rise in Medicare spending for such services,” a statement from the agency said.

Further comments from CMS were unavailable as public information officers have been furloughed because of the government shutdown.

The number of Americans suffering from sleep disorders is on the rise, and the Centers for Disease Control and Prevention estimates that almost 70 million people in the U.S. suffer from a lack of sleep, contributing to rises in obesity, hypertension, diabetes and depression, not to mention a loss of concentration and productivity.

Spending on the sleep studies also has been growing steadily, from $407 million in 2005 to $565 million in 2011.

In 2009, the CDC estimated that each month about 5 percent of the population falls asleep while driving as a result of lack of sleep.

Medicare patients can be referred for the tests only by doctors who believe it will diagnose a recognized sleep disorder such as sleep apnea. Federal guidelines say the tests should not be used when lack of sleep is likely the result of other causes such as depression or stress.

Tom Schatz, the president of Citizens Against Government Waste, a fiscal watchdog, said making improper payments is a problem in Washington that is getting increased attention.

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