Medicare DMEPOS Continues
As I have been posting here and everywhere, CMS has taken great pains to crack down on DME fraud.
Today’s Becker ASC Review (9/10/26—see below) has done an amazing job of summarizing most if not all of the crackdown efforts. And just yesterday, so you don’t think, “how come the same fraud does not occur with Medicare Part C?” well, think again. There are two actionable items only involving suppliers and Medicare Part C (AKA Advantage). Kudos to Becker’s for posting this story on their website.
Here are the highlights on the Medicare Part C crackdown:
DMEPOS suppliers CMS announced on Sept. 8 that it is barring 11 DMEPOS suppliers from earning future Medicare Advantage Part C and Part D payments, citing improper billing practices. These 11 were accused of $3.4 billion fraudulent billing in 2025 and 2026, according to CMS. The agency said the companies billed for deceased beneficiaries’ equipment and supplied devices to beneficiaries who never requested or received them.
Four of those 11 suppliers already had their traditional Medicare enrollments revoked. IMO, if you are booted from traditional Medicare, the Part C contracts should also be cancelled.
There is much more, and to read the whole story go to this link: https://www.beckersasc.com/supply-chain/the-dme-fraud-crackdown-in-10-numbers/?origin=OrthoE&utm_source=OrthoE&utm_medium=email&utm_content=newsletter&oly_enc_id=2558E3860112B6W
What this story does not discuss is the enhanced prior authorization for certain AFO (includes L1902, L1906, L4360/L4361, L1971, L4396/L4397) process for all new suppliers. That is those receiving a new PTAN. This goes into effect October 15 and will last one year.
—Paul Kesselman, DPM
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