Brief: Medicare Advantage Organizations and CMS Can Do More to Prevent Durable Medical Equipment Fraud in Medicare Advantage

Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) include medical items and supplies, such as wheelchairs, knee braces, and diabetic testing strips, that allow Medicare enrollees to manage an illness or injury. Fraud related to DMEPOS has long been an issue in Medicare, putting millions of taxpayer dollars at risk each year.

Thus far, CMS’s efforts to prevent DMEPOS fraud have mainly focused on Original Medicare, not Medicare Advantage. This issue brief by the Department of Health and Human Services’ Office of the Inspector General (OIG) focuses on fraud risks related to DMEPOS suppliers in Medicare Advantage. Medicare Advantage organizations (MAOs) and CMS take steps to screen fraudulent suppliers and prevent them from billing Medicare Advantage. However, gaps exist in this screening that can be exploited by bad actors. OIG recommends CMS take certain actions to address and prevent DMEPOS fraud.