Oxygen Plus: Unused Ventilators and the Claims That Kept Coming

In the Oxygen Plus fraud settlement, the company agreed to pay $200,000 to resolve allegations that it kept billing Medicare and Kentucky Medicaid for home ventilators patients no longer needed or used. The Justice Department’s October 17, 2023 announcement described more than 300 allegedly false claims between January 2017 and June 2021.

Oxygen Plus supplied durable medical equipment from Floyd County, Kentucky. The company settled with the United States and the Commonwealth of Kentucky over the continuing rental payments. A respiratory therapist’s account makes the allegation concrete: ventilators sat unused in patients’ homes while the company continued sending claims. For an employee who knows both the patient and the billing, that gap is the heart of this case.

What an NIV Rental Claim Was Supposed to Represent

Medicare and Kentucky Medicaid paid monthly for an NIV rental while the equipment remained necessary and reasonable for the patient’s treatment. Oxygen Plus supplied these non-invasive ventilators for home use to deliver pressurized air into the lungs of patients with serious respiratory diseases.

The monthly arrangement matters. Under Medicare’s equipment payment framework, ventilators fall into a category requiring frequent and substantial servicing. A non-invasive home ventilator generates recurring rental payments without the capped-rental endpoint and transfer of ownership that apply to a CPAP machine. The supplier retains ownership and the ongoing rental business.

That makes what happens after delivery central to the claim. A ventilator can remain in a patient’s home after the patient has stopped using it. The government’s Oxygen Plus allegation was that reimbursement requests continued after the need or use ended. In the government’s account, the billing relationship kept going after the treatment relationship had changed.

How Does DME Fraud Work?

In the Oxygen Plus complaint, the alleged DME fraud connected patient selection, pressure for ventilator orders and continued billing for unused equipment. The employees’ account starts before the device reached the home, with an existing customer list and a form titled “Questionable Vent Patients”.

The whistleblower complaint alleged that Oxygen Plus used the six-question form to identify Medicare and Kentucky Medicaid customers who were not already using ventilators. Once it selected a candidate, the defendants allegedly pressured health care providers to write a ventilator order for that person.

The complaint also alleged that the company solicited patients for home ventilators despite repeated objections from the respiratory therapist and other healthcare professionals. Many of the targeted patients had chronic obstructive pulmonary disease and likely qualified for a less costly respiratory assist device, such as a BiPAP, according to the complaint.

Those allegations put the clinical decision inside the sales process. The employees described the supplier finding a customer first and pursuing the order afterward. Taxpayers were paying for equipment whose need the company’s own therapist had questioned, according to the complaint.

When the More Expensive Category Drives the Order

The BiPAP allegation raises a question about which breathing device the patient needed. It also explains why product knowledge belongs alongside billing knowledge in a respiratory-equipment case. A person familiar with the treatment may see a mismatch that a claim described simply as a ventilator rental does not reveal.

In a separate complaint against QMES, a former employee alleged that the company billed Medicare for ventilators while supplying BiPAP devices.

The Employee Who Saw Ventilators Sitting Unused

The Oxygen Plus complaint alleged that a respiratory therapist discovered the continuing-billing problem during visits to patients’ homes in early 2019, soon after starting work. His job gave him a view of what happened after the equipment left the supplier:

Delivery had happened, according to the complaint; use was the missing piece.

The complaint separately alleged that Medicare paid Oxygen Plus $1,200 per unit each month for rented ventilators. A continuing monthly payment gives the unused machine a financial life of its own. That is why the distinction between having a device and using it matters to the taxpayer paying the rental bill.

For an insider, the important connection runs from the visit to the later claim. What did staff learn about use? Who received that information? What happened to billing afterward? Those are the decisions our whistleblower experts examine with someone who knows the patient-service and billing records.

The Push Toward More Ventilators

The complaint also quoted a message from a physician named as a defendant alongside Oxygen Plus, directing the company’s resources toward the NIV business and forecasting growth. Its instruction about the existing CPAP business was blunt:

Read beside the allegations about patient screening and objections from healthcare professionals, the message shows why an internal business instruction can matter. The company was directing attention toward ventilators while, according to the complaint, staff were questioning whether patients needed them.

Our whistleblower experts examine how that direction connects to particular equipment orders or continuing claims. An employee who saw the instructions, the patient visits or the billing decisions can explain a part of the business that the claim itself never describes.

In a separate NIV settlement, Lincare admitted that it sometimes kept seeking monthly payments when it knew patients were not using the devices.

What Is the Reward for a Medicare Fraud Whistleblower?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

The Oxygen Plus NIV settlement followed a qui tam case brought by two former employees. The two former employees were to receive 16% of the settlement between them, according to the Justice Department’s announcement.

An employee’s view of a home visit and an employee’s view of a billing account can reveal different parts of the same conduct. In this case, the complaint connected unused ventilators, disputed medical need and continued reimbursement requests. We work with insiders to understand how their own observations connect to the decisions behind the claims.

You Saw What Happened After Delivery

If you saw ventilators sitting unused while rental claims kept going out, talk with our whistleblower experts about the billing you know. We connect your knowledge of patient care and company decisions to the claims, bring in healthcare fraud whistleblower lawyers who understand respiratory-equipment billing, and stay beside you through the whole journey.