Accredited Sleep Disorder Center, HMS Diagnostics, Inc. Accused of Not Following Little Known Regulations

Houston, TX (PRWEB) November 23, 2007 -- The United States Attorney's Office in conjunction with the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation, conducted a ten month investigation of HMS Diagnostics, Inc. They have concluded that HMS Diagnostics, Inc. may have improperly billed certain CPT codes for sleep tests which Medicare should not have reimbursed. They stated that they believe submission of those claims violated the False Claims Act, stating that the technicians did not have the required certifications for billing CPT 98510 and CPT 98511 (42.C.F.R. 410.33 c ). The claims that are being called a violation go back as far as January 1, 2002 and potentially involve substantial penalties.

Consistent with most other Accredited Sleep Centers, HMS Diagnostics, Inc. worked under the belief that certified technicians were required to directly attend each patient as of October 1, 2007 (not before this date). Upon receiving the result of the investigation, HMS Diagnostics, Inc. has found numerous articles about this requirement with dates as varied as February 26, 2007, October 1, 2007 and, January 1, 2008. Date confusion and conflict is apparent and widespread in the literature of AASM, industry publications, legal opinions, and in the regulations themselves.

There is also a little known requirement that states, "If a technician leaves the company, if a new technician is hired or when a technician's license expires and he obtains a renewal, the IDTF must provide this information to the carrier on an amended 855B with attachment II. Failure to do so may result in suspension of its Medicare provider number."

The U.S. Attorney's Office also seems to be suggesting that any CPT 98510 or CPT 98511 study not actually performed by a credentialed technician cannot be billed. The effect of the fact that the credentialed technician is on site and supervising apparently is not a factor.

HMS Diagnostics, Inc. seeks to inform other well-intended diagnostic facilities and industry trade journals to pay extremely close attention to the potential pitfalls that have been created by government regulations and their interpretation by the government.

# # #