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.

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