Sleep Clinic Owner’s Nightmare: Sentenced to Prison for Medicare Fraud

The former owner of a Fresno, Calif. sleep clinic who faced up to 12 years behind bars for his part in a Medicare fraud scheme has been sentenced to just 19 months in prison following a plea deal.

Fraudulent Claims Uncovered: Inside the Medicare Scandal

Between March 2018 and September 2021 Travis Gober, owner of the VIP Sleep Clinic, submitted nearly $1 million in fraudulent claims to Medicare for sleep studies that were never performed, according to the original complaint. In some instances, the Medicare beneficiaries were deceased. In other instances, the Medicare recipients who received statements contacted the agency to report suspected fraud. according to court documents.

Behind the Scenes: How Medicare Fraud Was Executed

He used fake referrals from doctors since Medicare requires a physician’s referral to be reimbursed, according to court documents. Doctors interviewed by investigators indicated they had not made those referrals.

Gober committed this fraud, at least in part, to try to payoff financial debts and address other financial difficulties that his brother, Jeremy Gober, had caused the VIP Sleep Center and him to incur without his knowledge or consent, according to a news release.

Jeremy Gober, previously was charged with, and pleaded guilty to, healthcare fraud and aggravated identity theft. He is scheduled to be sentenced on May 20.

Brotherly Complications: The Intricate Family Dynamics in the Case

The case came to the attention of government investigators from two Medicare Administrative Contractors whose job it is to process and review Medicare claims submitted by healthcare providers. They look at claims for accuracy, verify the eligibility of the patient, and determine the appropriate reimbursement amount based on Medicare guidelines.

One of those contractors began reviewing complaints for services not performed. It determined that in several cases the Medicare patients for whom the claims were submitted were deceased. In many of the cases, the bills were in the tens-of-thousands of dollars, according to the complaint.

Investigators also interviewed physicians who purportedly made the referrals. Those interviewed indicated they either had not referred patients for sleep studies, or in cases that they did, it was not with VIP Sleep Center.

Medicare’s Vigilance: Unraveling the Fraudulent Claims

Although many of the claims were submitted to Medicare well after 2018, investigators determined that VIP had ceased operations in early 2018, at the latest. They also determined that numerous transfers were made from VIP Sleep Center’s checking account to Travis Gober for personal expenses as well as to his relatives.

Prevalence of Sleep Study Fraud: A Historical Perspective

Sleep study fraud is nothing new. In 2013, the U.S. Department of Health and Human Services conducted a study on questionable billing related to sleep clinics as a result of increased Medicare spending on sleep studies, along with growing concerns about fraud and abuse.

At that time the agency found that Medicare paid nearly $17 million for polysomnography services (a type of sleep study to diagnose and evaluate sleep disorders), that did not meet one or more of three Medicare requirements.

Costs and Consequences: The Financial Impact of Sleep Study Fraud

In 2019, OIG conducted another audit which found that Medicare made overpayments of $269 million for polysomnography services during a two-year period.

According to the Sleep Foundation, “the cost of a sleep study can range from less than $500 to more than $10,000, depending on insurance coverage as well as whether it is an in-lab or at-home study.”

The Rise of Sleep Medicine: Opportunities and Risks

The average price of an in-lab sleep study is $3,000. At-home sleep studies can range from $150 to around $1,000 or more.

The significant growth in sleep medicine over recent years brings increasing opportunities for fraudulent billing.

Legal Assistance for Medicare Audits: Safeguarding Your Practice

If you need legal assistance in defending a Medicare audit, or help creating an effective compliance plan for your practice, contact us. The Health Law Offices of Anthony C. Vitale represents healthcare professionals in state and federal court who are charged with fraudulent billing, illegal kickbacks, Medicare and Medicaid fraud, and false claims, among others. For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com