DOJ settles with two doctors and clinic in sleep disorder case, proceeds against other providers

by Ben Vernia | September 18th, 2014

On September 9, the U.S. Attorney’s Office for the Middle District of Florida announced that it had reached a settlement with two sleep specialists and a clinic in Jacksonville, and had intervened in a whistleblower’s suit against two other physicians who the government alleges allowed their names to be used as supervising physicians, but failed to serve in that role. According to DOJ’s press release:

Jacksonville, Florida B The United States has formally settled part of, and joined in part of, a lawsuit brought by a whistle-blower that alleges a Northeast Florida based sleep clinic intentionally billed the government for millions of dollars of services that were not medically necessary, and, in some instances, were never actually performed. The qui tam complaint, filed by a former employee of the clinic, alleges that the defendants – a sleep clinic and four physicians – violated the False Claims Act (FCA) by knowingly submitting false claims to the government for payment.

The government announced today that it had reached a settlement with the primary defendant, the Sleep Medicine Center, and two physicians – Dr. Hubert Zachary and Dr. George Restea. In reaching this settlement, the parties resolved allegations that, from January 1, 2010, until November 13, 2013, Zachary ran the Sleep Medicine Center, a clinic that treated patients for sleep-related disorders. Rather than treat patients in accordance with Medicare and TRICARE regulations, the United States contended that Zachary and the Sleep Medicine Center submitted claims for polysomnographic sleep studies and psychological testing that were not medically necessary, were not conducted by appropriately licensed individuals, or were not actually performed. Further, the United States alleged that, while Restea agreed to act as the Medical Director of the Center, he failed to properly supervise the center as he agreed to do. The Sleep Medicine Center agreed to pay $200,000 to resolve the claims and both the Center and Zachary voluntarily agreed to be excluded from participation in the federal healthcare programs for 8 years. Restea agreed to pay nearly $100,000 to resolve the claims.

Today’s actions mean that the government will move forward against remaining defendants Dr. John DeCerce and Dr. George Young. The government contends that these individuals also agreed to act as medical directors and staff physicians. While these doctors certified that they would supervise the clinic, the government alleges that the doctors merely lent their names in exchange for compensation. But for these physicians’ involvement, the lawsuit alleges, the Sleep Medicine Center would not have been able to bill the federal healthcare programs. For example, the government alleges that Dr. Young signed Durable Medical Equipment orders for patients that he never saw and Dr. DeCerce sleep study interpretations even when the machines allegedly performing the approved studies were broken.

* * *

The case was originally brought as a qui tam suit by a former employee of the clinic.

Leave a Reply

Recent Posts

Recent Comments