“The Social Security Act prohibits payment for devices used to deliver continuous and/or bi-level positive airway pressure (PAP) as items requiring frequent and substantial servicing, regardless of the illness the device is being used to treat. These claims will be denied. Using HCPCS codes E0450, E0460, E0461, E0463, E0464, E0465 or E0466 on a Medicare claim for a device used to deliver PAP to a beneficiary is not allowed and could violate the False Claims Act. This is true even if the same device could be used as a ventilator for a different beneficiary.”
A False Claims Act violation can carry penalties that total three times the amount of the claim, plus fines of $5,500 – $11,000 per claim.
Ventilators have been under heavy scrutiny for some time, with suppliers seeing audits from their DME MACs and even the Jurisdiction A RAC. The 2016 OIG Work Plan announced that non-invasive ventilation would also be under their review.