Respiratory care is a vital part of modern medicine. From oxygen therapy and nebulizers to CPAP machines and ventilators, respiratory services and equipment help millions of patients breathe easier. Unfortunately, that same complexity also creates opportunities for fraud.
Respiratory fraud in healthcare isn’t just about wasted money. It can mean patients receive unnecessary treatments, wrong equipment, or no real care at all. At the same time, insurers, Medicare, or Medicaid are billed for services that weren’t truly needed or never happened.
Identifying healthcare fraud and reporting it can help patients, families, and honest providers protect both health and resources.
What Is Respiratory Fraud?
Respiratory fraud occurs when providers, companies, or individuals intentionally misuse respiratory billing or services to get money they aren’t entitled to. This can involve:
- Falsely claiming patients need expensive respiratory equipment
- Billing insurance for services that were never provided
- Upcoding (billing for a more complex or costly service than was actually given)
- Providing unnecessary treatments just to generate revenue
These schemes often target vulnerable groups: seniors, people with chronic lung conditions, and patients who may not understand all the technical details of their care.
Signs of Healthcare Fraud
There are many kinds of respiratory fraud to be aware of. Here are some:
1. Unnecessary Respiratory Equipment
One of the most common schemes involves durable medical equipment (DME) like:
- CPAP/BiPAP machines
- Oxygen concentrators and tanks
- Nebulizers and inhalation therapy devices
- Ventilators and accessories
Fraudsters may:
- Convince patients they “must” have a device they don’t truly need
- Use aggressive telemarketing to sign people up for equipment
- Submit fake or exaggerated diagnoses for coverage approval
- Send equipment to patients who never asked for it, then bill insurance
Patients might not realize they’ve been enrolled until they see unusual charges or receive equipment they didn’t request.
2. Upcoding And Inflated Billing
Upcoding means billing for a more expensive service than what was actually provided.
In respiratory care, that can look like:
- Billing for a more complex respiratory therapy session than what occurred
- Claiming a patient used oxygen therapy continuously when they used it occasionally
- Coding simple CPAP supplies as more advanced or specialized items
These small changes add up to big overpayments over time.
3. Phantom Services
“Phantom services” are services that never happened, but are billed as if they did.
Examples in respiratory care include:
- Billing for home visits or respiratory therapy sessions that never took place
- Charging for refills of oxygen or respiratory medications that were never delivered
- Claiming patient monitoring or follow-ups that were never done
Patients and caregivers may not notice if they aren’t regularly checking their explanation of benefits (EOB) statements.
4. Misrepresenting Medical Necessity
Most payers require medical necessity for respiratory services and equipment. Fraud occurs when:
- Providers document false symptoms (like claiming severe COPD or sleep apnea when tests don’t support it)
- Test results are altered or exaggerated to justify the equipment
- Diagnoses are “upgraded” to conditions that qualify for higher reimbursement
In some schemes, patients are pushed through quick, low-quality screenings to create a paper trail, then signed up for long-term equipment rentals.
5. Kickbacks And Improper Referrals
Sometimes, fraud revolves around financial relationships between physicians, respiratory suppliers, and other entities.
Examples include:
- A provider receiving payments, gifts, or incentives for referring patients to a specific respiratory equipment supplier
- Companies are paying marketers to steer patients into unnecessary respiratory services
- Arrangements disguised as “consulting fees” or “marketing agreements” that are really kickbacks
These practices can violate anti-kickback and self-referral laws and lead to biased recommendations that aren’t in the patient’s best interest.
What To Do If You Suspect Respiratory Fraud
If something doesn’t feel right, there are steps you can take to prevent medical fraud:
- Talk to your doctor or care team: Ask them to explain your diagnosis, treatment, and any equipment in plain language.
- Check with your insurer: Call the number on your insurance card to review recent claims and ask about anything that seems suspicious.
- Keep detailed records: Save statements, bills, letters, and notes from phone calls; write down dates, names, and what was said.
- Report your concerns: Many insurers, Medicare, and Medicaid have fraud hotlines.
You can report anonymously, so that should not be an issue. Also, hiring a respiratory fraud attorney is a great step to take.
Frequently Asked Questions
How Can I Tell If I’m Being Given Unnecessary Respiratory Equipment?
Be cautious if you receive unrequested devices, feel pressured to sign forms, or are told, “Don’t worry, it’s free; insurance covers everything,” without a clear medical explanation.
Ask your doctor to walk you through your diagnosis, test results, and why the equipment is needed. If you’re still unsure, consider getting a second opinion.
What Should I Look For On My Insurance Or Medicare Statements?
Review your Explanation of Benefits or Medicare Summary Notices for:
- Respiratory therapy visits you don’t remember
- Charges for oxygen, nebulizers, or other devices you never used
- Ongoing monthly rental fees for equipment you returned or no longer have
If you see anything unfamiliar, call your insurer and ask them to explain each charge.
What Should I Do If I Suspect Respiratory Fraud?
Start by:
- Understanding medical fraud risks by consulting a respiratory fraud lawyer.
- Contact your doctor or clinic to ask about questionable charges or equipment.
- Call your insurance company or Medicare to report suspicious claims.
- Keeping written records of bills, statements, and conversations.
If you believe there is serious or large-scale fraud, you can also reach out to government fraud hotlines or consult with a healthcare fraud or whistleblower attorney to understand your options and protections.
Use Our Healthcare Fraud Detection Tips
Respiratory care can be life-changing when it’s done right and deeply harmful when it’s abused for profit. By staying informed, asking questions, and carefully reviewing billing and equipment, patients and families can play a powerful role in spotting respiratory fraud and protecting both their health and the healthcare system itself.
Use our healthcare fraud detection tips and prevent further healthcare fraud by contacting RHINO Lawyers.
We are Tampa’s go-to law firm and are ready to help you understand your case better and make the right decision regarding the respiratory fraud you are experiencing.
