Respiratory Therapists and Discharge Staff: When the Durable Medical Equipment Order Stops Matching Care

A respiratory therapist can be a DME whistleblower when firsthand knowledge of a patient’s care exposes false equipment claims. A home visit can show that a ventilator sits unused while the supplier keeps billing for it. If you work in respiratory care or discharge planning, the equipment recommendation, patient feedback or discontinuation notice you handled may explain where the treatment and the bill parted company.

SuperCare Health, a provider of home respiratory services and durable medical equipment, agreed to pay $3,315,308 in August 2021 to resolve allegations of billing Medicare and Medicaid for non-invasive ventilator rentals that patients no longer needed or used. A respiratory therapist who worked for SuperCare brought the qui tam case.

Ventilator Billing After the Patient Stops Using It

A ventilator billed after a patient no longer uses it puts the home visit and the monthly claim in direct conflict. In the SuperCare case, the government explained that Medicare and Medicaid reimbursed non-invasive ventilator rentals monthly when the equipment was necessary or reasonable for the patient’s treatment. It alleged that SuperCare kept submitting claims despite patients’ lack of need or use.

The home visit shows what happened once the equipment reached the patient. A recurring rental claim asks the government to keep paying. What the supplier learned when treatment changed, and what it billed afterward, connects the two.

For a discharge worker, the useful starting point may be the recommendation or communication you handled. For a therapist visiting the home, it may be the patient’s account or the machine’s usage record. The question we work through with you is how that information reached the supplier and whether its claims reflected it.

What a Respiratory Therapist Sees During Home Visits

Device settings, hours of use and maintenance needs can show whether the treatment described in a rental claim matches what is happening at home. The government’s case against Lincare makes those clinical details unusually concrete.

In its February 2024 settlement announcement, the Department of Justice described Lincare’s use of respiratory therapists to monitor home ventilator patients. During visits, therapists were supposed to evaluate settings, usage and maintenance, record how much patients used the devices, and confirm that use followed the physician’s directions.

Lincare’s own policy called for visits at least every 60 days. The company admitted that its clinical staff frequently missed those visits and that some centers lacked enough staff to monitor patients adequately. It also admitted that it could remotely monitor usage for certain newer ventilators but did not use those systems to confirm that patients were using the devices as directed.

Lincare agreed to pay $25.5 million to resolve claims over ventilator billing and coinsurance waivers. It admitted continuing to seek monthly payments in many instances without verified use or retained documentation of use, and in some instances when it knew patients were not using the equipment.

The admissions describe failures at different points. Sometimes the visit did not happen. For some patients, Lincare could check use remotely but kept billing without looking. Sometimes it knew the patient had stopped. Monthly claims continued through each of those failures. A therapist’s observation can put a patient and a specific rental behind what otherwise looks like another routine payment.

The Unused Ventilator in the Patient’s Home

Oxygen Plus shows how a therapist’s home visits can supply the firsthand account behind a non-use allegation. In a whistleblower complaint, the therapist described what he encountered:

The complaint also alleged that the company solicited patients for home ventilators despite repeated objections from the therapist or other healthcare professionals. It alleged that Oxygen Plus targeted many of these patients because they likely qualified for a less costly respiratory assist device, such as a BiPAP device. The clinical objection went to the choice of machine as well as whether anyone used it.

Oxygen Plus settled allegations of billing for respiratory devices patients did not need or use in 2023. Two former employees brought the case. The complaint’s account shows why an insider’s knowledge of what happened in the home can matter alongside the supplier’s billing records.

When Staff Raise Concerns and Billing Continues

If you are a respiratory therapist told to keep ventilator patients on a billing list, we want to understand what the patient-use records showed and who gave that instruction. The response to a clinical concern can explain why the next claim went out.

A separate Lincare oxygen case contains an explicit admission about that response. In the August 2023 oxygen-rental settlement, Lincare admitted that employees raised concerns about its billing practices and officials in its regional billing office and corporate headquarters told them the practices would continue. The case concerned oxygen equipment rental billing beyond Medicare’s 36-month payment cap. Lincare admitted improperly billing Medicare, Medicare Advantage plans and beneficiaries after the rental payments should have stopped.

Here the concern reached the people responsible for billing, and the answer was to continue. A discontinuation message, an internal objection and a later claim can tell a much more specific story than a general concern about sales pressure.

Respiratory Care by Unlicensed Personnel

Durable medical equipment respiratory care by unlicensed personnel has also led to False Claims Act settlements. The government alleged that North Atlantic Medical Services provided respiratory care through unlicensed personnel, resolving the matter in a 2014 oxygen and sleep-therapy settlement.

If your concern starts with who set up the device, fitted it or taught the patient to use it, that is the clinical handoff we need to understand.

The respiratory professional’s role is visible in another case. A former employee and licensed respiratory therapist brought the matter that led to J&L Medical Services’ settlement in 2016.

Oxygen Contents Billed but Never Delivered

Oxygen contents billed but not delivered create a direct comparison between the claim and the delivery history. In its 2018 settlement, Rotech Healthcare admitted knowingly billing Medicare for portable oxygen contents that beneficiaries did not use or require. It also admitted billing regardless of whether those contents were delivered.

For someone involved in home oxygen care, that distinction is concrete: the supplier claimed payment for contents, while the patient’s need, use or delivery told a different story.

CPAP use ending while rental billing continues raises its own patient-use question. The Medicare PAP coverage policy says the supplier is expected to ascertain when use stops and stop billing. Here, the insider’s contribution is knowing what stopped, when the supplier learned of it and what it continued to charge.

Referral Pressure Around the Discharge Handoff

Suppliers have a commercial stake in which company receives the patient referral. Inogen explains in its annual report that respiratory providers compete primarily on product features and service because Medicare, Medicaid and private payers establish reimbursement. That puts the competition around winning the referral and the resulting business.

Manufacturer support can enter that competition before a patient receives equipment. In the 2016 Respironics settlement, the government alleged that the manufacturer provided free call-center services to durable medical equipment suppliers that bought its sleep-apnea masks.

A later whistleblower complaint concerning Respironics alleged another form of commercial help: valuable physician-prescribing data supplied to durable medical equipment companies so they could target physicians for sales. The complaint alleged that Respironics provided the data to induce recommendations of its products. In September 2022, Philips RS North America, formerly Respironics, agreed to pay more than $24 million to resolve the kickback allegations.

For discharge staff, we examine the recommendation you handled alongside any supplier communications or commercial arrangement you know about. A referral arrangement can explain pressure that the billing department’s records alone would leave out.

What Evidence Is Needed to Report Medicare Fraud?

Your clinical knowledge is a starting point for a conversation with us, even if you cannot see the supplier’s submitted claims. We work with you to connect what happened in the home or at discharge to the equipment order and billing.

Your part of that account may concern the discharge recommendation, settings, patient training, feedback that treatment stopped, or a discontinuation notice that never changed the bill. We assess what you saw against the supplier’s claims and decisions, including who received the information and how they responded. That is where a concern about patient care can become a specific whistleblower case.

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

When Your Clinical Knowledge Contradicts the Bill

If you saw an unused ventilator, a disregarded discontinuation notice or pressure to steer a respiratory order, speak with our whistleblower experts about what happened to that patient and that bill. We work beside you to build your strongest respiratory equipment whistleblower case and bring in healthcare fraud whistleblower lawyers who understand supplier billing and referral arrangements. We keep your firsthand knowledge at the center of the case and stay with you through it.