Sylvia Rael, MD
Pulmonary Disease · Omaha, NENPI 1386648095
Payments from drug & device makers
What this record shows
This record is dominated by food and beverage: $1,345 of the $1,502 with a category attached, or 89.5%. 22 manufacturers reported payments, led by Inspire Medical Systems, Inc. at 24.4% of the total. 2025 is the largest year on record at $673, 3.6 times the $188 reported in 2019. That places this record below the midpoint for pulmonary disease clinicians in NE, where the typical reported total is $2,614.
Across 70 payments — averaging $21.46 each. Meals, travel, consulting and speaking fees, gifts and royalties reported by drug and device makers.
- Inspire Medical Systems, Inc.$367
- Jazz Pharmaceuticals Inc.$142
- Insmed, Inc.$121
- Itamar Medical Inc$115
- Grifols USA, LLC$95
- AstraZeneca$83
- plus $580 from 16 others
What the payments were for
- Consulting fees$352%
- Food & beverage$1,34590%
- Education$1228%
Most of this is food and beverage — typically meals provided during product presentations at a clinic or hospital. Nationally that is the single largest category of reported payments by count.
General payments by program year
Who reported the general payments
Companies are grouped under their corporate parent — a single manufacturer often files under several CMS reporting entities. Research and ownership payments are counted separately and are not in this table.
| Company | Payments | Total |
|---|---|---|
| Inspire Medical Systems, Inc. | 12 | $367 |
| Jazz Pharmaceuticals Inc. | 4 | $142 |
| Insmed, Inc. | 7 | $121 |
| Itamar Medical Inc | 2 | $115 |
| Grifols USA, LLC | 4 | $95 |
| AstraZeneca | 6 | $83 |
| GSK | 5 | $67 |
| Boehringer Ingelheim | 4 | $58 |
| Medtronic | 2 | $55 |
| Harmony Biosciences LLC | 3 | $54 |
| Avadel CNS Pharmaceuticals, LLC | 3 | $51 |
| Sanofi | 3 | $49 |
| Genentech USA, Inc. | 3 | $40 |
| Philips North America LLC | 2 | $37 |
| Regeneron Healthcare Solutions, Inc. | 2 | $33 |
| Amgen | 2 | $30 |
| Bayer | 1 | $28 |
| United Therapeutics Corporation | 1 | $19 |
| Actelion Pharmaceuticals US, Inc. | 1 | $17 |
| Mylan Specialty L.p. | 1 | $15 |
| Verona Pharma, Inc. | 1 | $15 |
| Axsome Therapeutics, Inc. | 1 | $14 |
What the payments were tied to
Products named in the reported payments. Only payments of $100 or more are attributed here — the typical reported payment nationally is a meal worth about $16, and listing those product-by-product would be noise.
- Inspire$122
How this compares
$1,502 in reported general payments places this provider in the 40th percentile of 81 pulmonary disease providers in Nebraska.
Medicare billing
What this is not: this is the amount Original Medicare Part B allowed for services this provider billed in 2024. It is not their income. It excludes Medicare Advantage — now more than half of all Medicare enrollment — along with Medicaid and all commercial insurance, and it is gross practice revenue before staff, rent, supplies and malpractice premiums. CMS also suppresses any figure covering ten or fewer patients, so low-volume providers appear smaller than they are.
Most prescribed under Part D
| Drug | Claims | Cost to plans & patients |
|---|---|---|
| Prolastin CAlpha-1-Proteinase Inhibitor | 13 | $173,978 |
| Trelegy ElliptaFluticasone/Umeclidin/Vilanter | 190 | $133,022 |
| Breztri AerosphereBudesonide/Glycopyr/Formoterol | 40 | $36,419 |
| Spiriva RespimatTiotropium Bromide | 30 | $22,551 |
| Breo ElliptaFluticasone/Vilanterol | 39 | $21,960 |
| Anoro ElliptaUmeclidinium Brm/Vilanterol Tr | 35 | $14,197 |
| Stiolto RespimatTiotropium Br/Olodaterol Hcl | 17 | $11,531 |
| Arnuity ElliptaFluticasone Furoate | 33 | $8,555 |
| SymbicortBudesonide/Formoterol Fumarate | 17 | $6,859 |
| Incruse ElliptaUmeclidinium Bromide | 15 | $5,344 |
| Albuterol Sulfate HfaAlbuterol Sulfate | 100 | $2,363 |
| Ventolin HfaAlbuterol Sulfate | 15 | $923 |
| Modafinil | 19 | $651 |
| Azithromycin | 69 | $462 |
| Prednisone | 70 | $223 |
Paid to pharmacies, not to this prescriber.
Companies that both paid and supply prescribed drugs
These companies both reported payments to this provider and make drugs the provider prescribed under Medicare Part D in 2024. For most specialties this overlap is expected — a cardiologist who is paid by a cardiology drugmaker also treats heart disease. It is shown so the reader can see it, not because it implies anything on its own.
| Company | Paid to this provider | Part D cost of their drugs |
|---|---|---|
| GSKTrelegy Ellipta, Breo Ellipta, Anoro Ellipta, Arnuity Ellipta, Incruse Ellipta | $67 | $183,078312 claims |
| Grifols USA, LLCProlastin C | $95 | $173,97813 claims |
| AstraZenecaBreztri Aerosphere, Symbicort | $83 | $43,27857 claims |
| Boehringer IngelheimSpiriva Respimat, Stiolto Respimat | $58 | $34,08247 claims |
Reading this fairly. The Part D column is what drug plans and patients paid pharmacies — this provider received none of it, and it reflects how many patients they treat and what those drugs cost. Against peers, this provider's reported payments sit in the 40th percentile of 81 pulmonary disease providers in Nebraska.
Other pulmonary disease in Omaha
- Stephen RennardOmaha$50K
- Douglas MooreOmaha$40K
- Adam WellsOmaha$26K
- Zachary DepewOmaha$26K
- Michael SanleyOmaha$17K
- Adam HighleyOmaha$15K
- Carolina LandeenOmaha$14K
- Patrick MeyersOmaha$12K
- John DickinsonOmaha$8K
- Palvannanathan GanesanOmaha$8K
Where these figures come from
- Payments: CMS Open Payments, program years 2019–2025 (publication P06302026_06032026).
- Billing: Medicare Physician & Other Practitioners, data year 2024. Original Medicare Part B only.
- Identity: NPPES NPI Registry, July 2026.