Have you noticed something off in your workplace that makes you question whether respiratory fraud might be happening? Maybe it’s repeated billing for unnecessary equipment or a pattern of pushing patients toward devices they don’t need.
Respiratory fraud isn’t just a frustrating workplace issue. It’s a serious problem affecting patient trust, wasting valuable healthcare dollars, and misdirecting resources away from those who truly need them.
The good news? You have the power to make a difference. By learning how to spot respiratory fraud and knowing how to report it, you can help protect patients, recover taxpayer dollars, and bring unethical practices to light. Here’s everything you need to know to take action with confidence and clarity.
What Is Respiratory Fraud?
Respiratory fraud happens when illegal practices are used to profit from respiratory care services or rental equipment. This could include items like nebulizers, ventilators, oxygen supplies, and other essential durable medical equipment (DME). However, instead of helping patients, dishonest actors exploit billing systems, overcharging insurance programs like Medicare. And the impact is significant.
Healthcare fraud costs the system billions of dollars annually. That means fewer resources for patients and inflated costs that trickle down to everyone. It also chips away at the integrity and trust within the healthcare industry.
Examples of Respiratory Fraud
Unfortunately, there are many ways respiratory fraud can unfold. Here are some of the most common practices you might spot in the workplace:
- Double Billing: Charging insurance companies multiple times for the same equipment or service.
- Unnecessary Equipment: Prescribing devices patients don’t need, or billing for devices never actually provided.
- Fraudulent Tests: Conducting unnecessary diagnostic tests as a way to justify billing for high-cost devices or treatments. Also, routinely billing for monthly rental items that patients do not use or have any compliance with the rental item.
- Kickback Schemes: Offering financial incentives to doctors or staff members to recommend certain equipment suppliers or services.
- Data Mining Patients: Exploiting patient records to push them toward expensive, medically unnecessary devices.
- Routine Waivers of Co-insurance: Forgoing legally required patient co-pays to entice patients, which can violate federal laws.
- High-Pressure Sales Tactics: Encouraging staff or sales teams to push equipment or services onto patients, regardless of their actual medical needs.
Fortunately, whistleblowers play a vital role in exposing these practices and protecting public funds. Whistleblowers have been instrumental in recovering millions of taxpayer dollars and stopping these illegal schemes.
For example, a recent case resolved by DJO Whistleblower Law Group resulted in a $25.5 million settlement with Lincare Holdings, Inc. This Florida-based company agreed to a settlement after it was exposed for overbilling Medicare and Medicaid for non-invasive ventilator rentals.
Lincare also faced allegations of violating the Anti-Kickback Statute by waiving patient co-insurance payments. This case was only possible because whistleblowers took swift and brave action to report what they witnessed.
How You Can Spot Respiratory Fraud
Recognizing the signs of respiratory fraud often requires someone who’s close to the process, such as a medical billing associate, respiratory therapist, or equipment technician. Here are a few red flags that could signal something is wrong:
- Billing Discrepancies: If you notice repeated claims for the same equipment or unusually high charges, it could indicate intentional overbilling.
- Unnecessary Prescriptions: Watch for respiratory devices being prescribed without any clear medical need. No documentation? Red flag.
- Improper Documentation: Missing or incomplete patient files is another common indicator. Equipment needs should always be verified and certified.
- Suspicious Behavior: If sales reps or supervisors encourage staff to adjust billing records, exaggerate patient needs, or skip essential documentation, pay attention—these are classic red flags.
If something feels off, trust your instincts. These patterns often add up to something that warrants a closer look.
How to Report Respiratory Fraud
Once you’ve noticed potential warning signs, the next step is to take action. Reporting fraud doesn’t have to be complicated. You just need the right guidance and a trusted ally to walk you through the process. Here’s how to do it.
1. Document Your Observations
Keep careful records of what you observe. This might include billing codes, patient files, email communications, or anything else that highlights irregularities. Having clear evidence can strengthen your case and simplify the process.
2. Do Not Speak Publicly About Your Concerns
While it’s natural to want to discuss your observations with coworkers, it’s essential to handle the matter privately. This ensures the integrity of any investigation and helps avoid miscommunication.
3. Get in Touch with a Whistleblower Attorney
A specialized whistleblower attorney can guide you through the reporting process and help you file your claim correctly. This ensures your rights are protected and your case gets the right level of attention from authorities.
4. Work with Investigators
Your attorney will help connect you with authorities and collaborate on building a strong case. This could include additional evidence or interviews to solidify the claims and ensure accountability.
Think Respiratory Fraud Is Happening at Your Job?
Respiratory fraud is a major challenge to healthcare, but with the right tools and knowledge, you can take action against it. By recognizing the warning signs, gathering evidence, and working with trusted whistleblower attorneys, you can play a critical role in fighting fraud and recovering stolen taxpayer dollars.
At DJO, we specialize in helping whistleblowers bring their cases forward with confidence. Remember, we only get paid if you do. With potential rewards of up to 30% of recovered funds, your actions can create meaningful change not just for taxpayers, but for the future of ethical healthcare.
Report respiratory fraud today. Your courage could make all the difference.
authored by Christopher J. Piacentile
Director of Investigations DJO Whistleblower Law Group
