Moratorium fallout: Providers fear growth stagnation, bid setbacks

YARMOUTH, Maine – A six‑month, nationwide moratorium on new Medicare enrollments for DMEPOS providers is expected to have the biggest impact on growth plans, according to 31% of respondents to a recent HME Newspoll.

The moratorium, which began in late February, prevents existing providers from opening new locations with new Medicare PTANs, effectively halting expansion efforts for many.

“I understand the direction, as the industry did it to themselves,” wrote one respondent. “I don’t like it, as we are expanding locations and this will have an impact.”

Impact on competitive bidding and RID

Thirteen percent of respondents said the moratorium’s biggest impact will be on bid preparation for the next round of Medicare’s competitive bidding program (CBP). The new remote‑item delivery (RID) framework requires providers to serve patients nationally, an approach that depends heavily on geographic expansion.

“It will basically put us out of business if it causes us to not be allowed to participate in the RID CBP,” wrote another. “We have a plan in place to qualify and were working on it until the moratorium came out. Now, it is all uncertain. Basically, it is preventing competition.”

Concerns over intent and market consolidation

Some respondents believe the moratorium aligns with CMS’s stated goal of reducing the number of suppliers as part of the RID CBP.

“This policy appears to disproportionately benefit large health care corporations and managed care organizations by further consolidating their control over the health care market,” wrote one respondent. “Rather than improving patient care, it risks creating conditions that push independent providers out of the system. Patients – especially seniors and those in rural communities – lose access to local, personalized care.”

Other reported areas of impact:

• Mergers and acquisitions: 28%
• Policies for other payers: 12%
• Other: 16%

Skepticism that the moratorium will reduce fraud

Despite CMS framing the moratorium as a fraud‑prevention measure, most respondents doubt its effectiveness.

Fifty‑six percent believe it will not reduce fraud, and another 25% are unsure.

“People who do fraud will continue doing fraud in new ways and it’s not fair for us who work honestly to go through all these changes because of them,” wrote one respondent.

What providers say would actually reduce fraud

Respondents acknowledged fraud is an issue, but they offered a range of alternative strategies they believe would be more effective than a blanket moratorium:

• Stronger provider screening
• Enhanced accreditation oversight
• Data‑driven program integrity tools (e.g., flagging spikes in specific codes)
• 100% audits prior to payment for the first six months
• “Hard prison time” (“Fines and recoupments are like speed bumps,” one respondent wrote.)
• Physical inspection prior to issuing a provider number
• Required signed CMN with each claim submitted

“CMS has an internal issue of not monitoring claims paid to a possible fraudulent company for several years,” wrote Steve Nyhuis of SIXONESIX HME Advising. “This moratorium is a poor excuse for governmental oversight issues. AAHomecare and VGM need to fight this change. We need to convince CMS to give us a seat at the table and work together on stopping fraud.”

Related reading:

• Industry stakeholders seek changes to bid framework, enrollment moratorium
• VGM reintroduces fraud resource center
• CMS’s freeze on enrollment chills deals, bid prep
• Administrator Oz: CMS must ‘shut the whole country down’ to stop DME fraud