DME billing, is this Fraud?

[IBFeral]

Just received CPAP supplies from DME.  I received a new mask starter kit for Airfit N30 that I wanted to try.  On the shipping delivery ticket was the starter kit as well as an additional listing for head gear that was part of the kit but not a separate item in the delivery.  I called and told them that I did receive the head gear that is part of the kit but didn't receive a second head gear as shown on the ticket.  They explained that as this is an insurance billing they always bill for the kit and for the head gear even though the kit includes head gear. 

Sounds fishy to me my question is this fraud?

[sheepless]

imo, yes. it's all too common a scam to double charge when there are separate codes for parts of complete packages. see my similar experience here: http://www.apneaboard.com/forums/Thread-...vercharges

dme blames it on the insurer. insurer blames it on the dme. it'll continue as long as we don't complain. shop around for a more fair-minded dme, if there is such a thing.

[SarcasticDave94]

Common trick where DME and insurance blame each other for the problems in billing on the public front, AKA the answer they tell you. Privately they probably have an acceptance agreement to do this to inflate pricing by double dips in fees, where 1s and 0s bounce around from one to the other and somehow balances out between themselves only. Except we forgot of course YOUR portion, which has gotten inflated, which also of course comes from YOUR pocket.

[Gideon]

Also IMHO.
They do the same with the PAPs.
The original PAP machines a long time ago in a land far, away you had to get the parts separately, so they still bill that way.

This is one place. government could make a difference. If they kit out a mask it should be such that you have to assemble it. The BOM should match what you received.

Put a letter together, hey insurance, this is what they billed for, and this is what I received, include part numbers.

[Melman]

Billing for Resmed Airsense 10 models is a good example. The humidifier is part of the machine but, since, it has a separate code, DMEs bill for the chamber in addition to the machine,

[sheepless]

I was charged for the chamber AND the humidifier. the humidifier is built into the machine and presumably is not considered user replaceable. I can understand having a separate code for certain repair parts but imo that should only be applied if/when it needs to be replaced. the chamber is always provided, or should be. because it's recommended to be user-replaced periodically it makes sense to have a separate code for that too, but imo it's fraudulent to separately charge for anything that comes from the factory pre-installed.

[Hydrangea]

I agree with all of the above. It is a sham. But it's a sham that both the insurance & the DME benefit from, so they both play along.

Shop around to a DME that doesn't do that, if you want to not corroborate. But it may be tough to find a DME *that takes your insurance* that does not bill like that.

[SarcasticDave94]

Oh BTW, way back in early 2017 when I'd failed compliance on my BPAP, later revealed due to high Central counts, so I had to return the DreamStation BPAP Auto to the DME's office. They had billed the insurance for the BPAP and humidifier. Then upon return, they said the humidifier wouldn't be accepted in the return. It was paid for in bill 1. Then the joker manager says "Good luck in getting a humidifier again. Insurance only buys one humidifier." Says I what about ResMed? Their humidifier is built-in. "Doesn't matter sir. We always separate the humidifier out as a line on the bills. It'll always look like a separate part and a separate purchase. So likely you can't even buy ResMed. Besides Respironics is just as good."

Yes to some Respironics is fine, not here to dispute it. And besides the fact ASV isn't the right therapy anymore, insurance has in fact bought 2 ResMed units for me with humidifier intact.

The moral? DME's are run by the same class of people that run for office. You can easily verify a lie vs truth with this class of human-like beings. Every time that mouth opens, just wait for the lie to spring forth.