The Nation’s Challenge to Combat Durable Medical Equipment Fraud in Medicare

Report Materials

• Full Report (PDF, 2.0 MB)
• Report Highlights (PDF, 277.4 KB)
• Featured Topic: Durable Medical Equipment

Each year, bad actors defraud Medicare and taxpayers of millions of dollars by billing for durable medical equipment that enrollees do not need or never receive. Despite efforts to combat this fraud, bad actors continually devise new schemes. Bold action is needed to address the underlying problems that allow durable medical equipment fraud to persist.

CMS has recently taken steps to increase its fraud-fighting efforts. For example, CMS has created a new Fraud Defense Operations Center to more proactively identify suspect billing and suspend payments. However, given the extent of durable medical equipment fraud in Medicare and the continuously evolving nature of durable medical equipment fraud schemes, more specific attention is needed to understand and prevent this type of fraud.

This white paper presents actions that CMS and others can take to stop bad actors from exploiting Medicare. It focuses on three elements that bad actors need to commit fraud: a Medicare-enrolled supplier, a physician order, and an enrollee identification number.