Tips for Identifying Fraud in the Respiratory Industry Such as High-Pressure Sales Tactics, and Other Fraudulent Activities

Selling medical supplies, such as respiratory devices, puts a tremendous amount of pressure on organizations– quotas to meet, new clients to secure, and fierce competition on their heels.

While many respiratory device companies are able to navigate the competitive landscape with integrity and honest approaches, there are some who resort to fraudulent tactics to get ahead. When that happens, it’s critical that the behavior is recognized and reported.

Individuals can step up and report deceitful and/or illegal practices and potentially earn rewards for doing so. Here are tips for identifying fraudulent activity in the respiratory industry:

  • Data Mining patients in order to put them on more expensive and medically unnecessary devices.
  • Routinely and continually billing monthly for non-compliant patients
  • Routine waivers of patient co-insurance
  • Billing insurance companies for respiratory products or services that never occurred
  • Companies forging or changing medical orders to obtain payment of respiratory products or services
  • Avoiding or delaying lawful return of rental equipment
  • Multiple billing for home sleep testing

High-pressure sales tactics

There’s a fine line between being an aggressive salesperson and participating in fraudulent activities that warrant reporting. It should raise a red flag if your organization is promoting the following:

  • Emotional Manipulation (White Coat Marketing) – praying on people’s emotional state is unfortunately easy in the respiratory industry. Using fear tactics to convince someone their health or life is at stake without your product is unethical at the very least.
  • Reciprocity – guilting someone into making a purchase because of a free gift, sample product, or other “throw in” is not acceptable.
  • Inflating or falsifying claims – making false claims, outrageous promises, and exaggerating past results is unethical and illegal.

These are just a few examples of high-pressure sales tactics. As a general rule of thumb, if your organization is asking you to sell in a way that makes you uncomfortable or that would make you feel pressured as a client, it’s worth taking a closer look.

Offering kickbacks

The Anti-Kickback Statute exists to prevent medical companies from offering kickbacks to hospitals, physicians or any referral source when federal monies are involved. This statute even applies to commission only sales people. Violators of this act can face imprisonment and/or tens of thousands of dollars worth of penalties.

Kickbacks can look like gifts of a certain monetary value, discounts, incentive bonuses or even compensation. Be very careful when there are offers of exchanging anything of value for sales of a certain service or device. Familiarize yourself with the Anti-Kickback Statute so you have a guideline of when it’s being broken.

Data mining

If your organization is using information about existing patients as part of your sales strategy in order to push unwanted medical services or equipment there’s a chance it may be considered unethical and possibly illegal.

What to do if I suspect fraud in the respiratory industry?

Discovering fraudulent activities is undoubtedly a scary realization. You might not know what the first step is, or how to protect yourself during the reporting process.

It’s important to know that you are not alone — you have professionals to support and guide you through the brave process of speaking up for what’s right. The experts at the Daniel Ocasio Whistleblower Law Group are here to support you every step of the way.

Your information could be valuable. To take the first step, send us a message today and our experts will respond with your confidentiality guaranteed. You deserve the peace of mind of being protected along the way.


Tips for Identifying Fraud in the Respiratory Industry Such as Billing for Services that Never Occurred, Multiple Billing for Sleep Testing, and More

Those who work in the respiratory field are tasked with paying meticulous attention to detail every day. It is not a simple task, ensuring all medical services performed, recorded, and billed properly.

Unfortunately, there are individuals looking to cheat the system and take advantage of medical billing practices for personal profit. When that happens it’s crucial to report it immediately to rectify the situation and hold the perpetrators responsible.

The first step in reporting fraudulent activity in the respiratory industry is recognizing that it’s happening. Here are tips for identifying various types of fraud, and what to do if you find yourself a witness to it.

Billing Medicare, Medicaid or Tricare for products or services that never occurred

One of the most common instances of fraud is to bill the Government for products or services that never occurred in order to make a profit.

A tell-tale sign that Federal insurances are being billed for things that didn’t happen is a lack of supporting documents. When you receive a claim to be processed, be sure to immediately locate all the supporting documents related to the visit or service.

Unnecessary treatments

Billing for services that aren’t necessary is another type of common fraud. Not only do unnecessary treatments prey on the healthcare system, they put patients through needless regimens.

If you’re noticing the same products or services being submitted for all patients, it’s likely that product or service isn’t medically necessary and is being done across the board for insurance purposes. Keep an eye out for that red flag and any other signs that the doctor is requesting unnecessary treatments.

Multiple billing for Home Sleep Testing

Certain respiratory issues, like sleep apnea, can be tested at home while the patient is sleeping. Since the testing is not done in the office, bad actors take it as an opportunity to take advantage of the lack of visibility.

Multiple billing for Home Sleep Testing may appear as billing the same test under multiple CPT codes, billing for multiple nights under the same CPT code or billing for multiple tests when only one was done. Either way, multiple billings for Home Sleep Tests usually should raise a serious concern.

What to do if you witness fraud in the respiratory industry

Realizing that you’ve witnessed medical billing fraud is frightening and can leave you wondering what’s the right course of action. While there is whistleblower protection under the False Claims Act and other similar laws, it’s still scary to take the risk and report what you’ve witnessed.

The good news is you don’t have to do it alone. There are dedicated teams that exist to help you get the protection you need and potentially the reward you deserve for doing the right thing.

If you suspect fraudulent activities are taking place at your office, don’t hesitate — reach out to the team at the Daniel J. Ocasio Whistleblower Law Group for a confidential consultation and take the first step in protecting integrity and speaking up against fraud.