The Centers for Medicare & Medicaid Services has barred 11 medical-equipment suppliers associated with more than $3.4 billion in suspected fraudulent billing during 2025 and 2026 from receiving future Medicare Advantage and Part D payments. CMS said these companies billed for multiple beneficiaries who were deceased on the reported dates of service and for equipment that beneficiaries never requested or received. The suppliers also allegedly billed for equipment that beneficiaries never requested or received, according to CMS.
The agency’s Preclusion List now includes these suppliers, meaning Medicare Advantage plans must deny payment for items and services furnished by them, while Part D sponsors must reject claims for drugs prescribed by listed providers. CMS Administrator Dr. Mehmet Oz stated, “The suppliers also allegedly billed for equipment that beneficiaries never requested or received.” The suppliers had not submitted Medicare claims before 2025 and used improper billing practices, according to CMS.
Fraudulent Billing Practices Exposed
Four of the companies had already lost their billing privileges under Original Medicare and subsequently began billing Medicare Advantage plans. Investigations revealed claims for catheters and orthotics with dates of service after beneficiaries had died. A Florida supplier submitted approximately $18.4 million in catheter claims over two consecutive days in December 2025, including $6.1 million for 500 beneficiaries on Dec. 15 and $12.3 million for 777 beneficiaries the following day.
Read Also: Почему пациенты выбирают коронки E.max для восстановления зубов
A Texas company billed approximately $5.5 million for orthotics, with six beneficiaries interviewed by investigators stating they did not know the ordering providers, had never heard of the suppliers, and did not need the equipment. CMS also identified claims with dates of service after nine beneficiaries had died and determined that the company was not operating at its reported location.
Wider Impact and CMS Response
Medicare spends more than $7 billion annually on durable medical equipment, prosthetics, orthotics, and supplies through Original Medicare alone, according to the Department of Health and Human Services Office of Inspector General (OIG). CMS has suspended $5.7 billion in suspected fraudulent Medicare payments during 2025, prevented $1.5 billion in suspected fraudulent medical-equipment billing, revoked the billing privileges of 5,586 providers and suppliers, and referred 372 cases encompassing $3.7 billion in billing to law enforcement. An August OIG report concluded that fraudulent medical-equipment billing persists despite existing safeguards because schemes continue to exploit three essential components: a Medicare-enrolled supplier, a physician order, and a beneficiary’s identification number.
In May, CMS imposed a six-month nationwide moratorium on new Medicare enrollment for hospice and home health agencies, following a similar moratorium for certain durable medical-equipment suppliers. Proposed Medicare enrollment changes would give CMS additional authority to remove noncompliant providers and recover improper payments, potentially saving approximately $82 million annually. CMS previously changed Medicare Shared Savings Program calculations to shield accountable care organizations from anomalous catheter billing attributed to a small group of suppliers.
