CMS announces temporary moratorium on new Medicare enrollment for certain DMEPOS suppliers

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) will implement a six-month nationwide moratorium on the Medicare enrollment of DMEPOS supplier medical supply companies, according to a notice in the Federal Register.

What suppliers are impacted?

The moratorium will affect the following supplier types:

• Medical supply company
• Medical supply company with orthotics personnel
• Medical supply company with pedorthic personnel
• Medical supply company with prosthetics personnel
• Medical supply company with prosthetic and orthotic personnel
• Medical supply company with registered pharmacist
• Medical supply company with respiratory therapist

What's behind CMS's decision?

In a press release, CMS says the moratorium will allow it to explore additional safeguards to further mitigate what it calls longstanding instances of fraud, waste and abuse perpetrated by certain DMEPOS companies. It applies to all applications for initial enrollment and changes in majority ownership for medical supply companies.

In the notice, the agency provided the following:

• The seven types of medical supply companies listed were all in the top 20 out of over 80 DMEPOS supplier specialty types when looking at the highest percentage of DMEPOS suppliers of a specific specialty type that were revoked at least once since 2023. 
• Five of the seven types of medical supply companies were in the top 10 when reviewing the highest percentage of DMEPOS suppliers with a payment suspension since 2023.
• Six of the seven types of medical supply companies were in the top 10 when examining the highest percentages of law enforcement referrals since 2023. 
• All seven types were in the top 15 when looking at the highest percentage of BIU complaints for each DMEPOS supplier type since 2023. 

Additional measures

The agency also plans to publish information on suppliers whose participation in the Medicare program has been revoked, including their National Provider Identifier (NPI) and the reason for the revocation. This additional transparency, it says, will allow patients and payers, including private insurers, to understand which providers have been subject to such administrative enforcement action by the government.

Will Medicaid follow suit?

CMS says it is allowing each state to decide whether some form of a DME moratorium is appropriate for their respective Medicaid and CHIP programs.

"Each state has greater expertise and experience with their pool of DME provider types, including the requirements for each type of DME provider, than CMS," it states. "Nevertheless, CMS encourages each state to, as appropriate, implement a DME provider moratorium tailored  to the specifics of their beneficiary population as well as any geographic considerations. Additionally, CMS is offering every state and territory the opportunity to consult with CMS on the prospect of implementing a Medicaid- or CHIP-based (or both) DME moratorium in their jurisdictions." 

Latest effort to crack down on health care fraud, CMS says

The agency says these new efforts build on the agency stopping more than $1.5 billion in suspected fraudulent billing in this area this year. It also highlighted recent efforts to address what it says are abusive pricing practices for skin substitutes, which helped to lower premiums by $11 per month for Medicare beneficiaries by reducing overall Part B spending.

The six-month moratorium is part of a larger announcement by the Trump administration on its latest major crackdown on health care fraud, it says.