Snap Diagnostics, LLC (SNAP), an Illinois-based “home sleep testing diagnostics services” provider, will pay $3.5 million to settle allegations that it defrauded federal health care programs, according to a June 6 press release from the U.S. Department of Justice (DOJ).
The settlement resolves allegations that were brought under the qui tam, or whistleblower, provisions of the False Claims Act through two civil lawsuits. According to the press release, the government “intervened in the two lawsuits and filed a complaint in intervention prior to the settlement.”
The False Claims Act’s qui tam provisions enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs.
The government alleged that SNAP, its founder Gil Raviv, and its vice president Stephen Burton, “violated the False Claims Act and the Anti-Kickback Statute by fraudulently billing Medicare and four other federal health care programs for medically unnecessary services and for services that were occasioned by kickbacks.” The lawsuit alleged that Raviv instructed SNAP “to submit claims for patients’ second and third nights of home sleep testing when, in fact, the company knew that only a single night of testing was needed to effectively diagnose obstructive sleep apnea.” Additionally, SNAP allegedly “routinely tested and claimed only one night for patients with private health insurance.”
The lawsuit alleged that SNAP defrauded “five federal agencies” and also “unlawfully multiplied the copays it received from senior citizens who were Medicare beneficiaries.” Additionally, the government alleged that the company’s “business model relied on several unlawful kickback schemes, which incentivized physicians and their staffs to refer all of their home sleep testing services to SNAP.”
The settlement agreement was approved by U.S. District Judge Mary M. Rowland: SNAP will pay $3.5 million, Raviv will pay $300,000, and Burton will pay $125,000. The total settlement amount is $3.925 million. As part of the agreement, “SNAP and Raviv also entered into a corporate integrity agreement with the Office of Inspector General of the U.S. Department of Health and Human Services,” which requires SNAP to “retain an independent review organization to perform annual reviews of claims and submit reports to the OIG-HHS,” among other things.
“When health care providers violate their obligation to properly bill for federally funded treatment, government programs and American taxpayers pay the price,” U.S. Attorney John R. Lausch, Jr., said in the press release.
Whistleblowers are key to uncovering fraud and corruption in the healthcare industry: fraudulent schemes can be particularly harmful to patients and erode trust in the medical system. In Fiscal Year 2021, whistleblowers helped the DOJ recover $1.6 billion in settlements. The DOJ highlighted health care fraud as “the leading source of the department’s False Claims Act settlements and judgments.”