CMS Has Barred Eleven Equipment Suppliers From Medicare Advantage and Part D. Four Had Already Been Thrown Out of Original Medicare.

Medicare is not one payment system. A supplier thrown out of the traditional programme can, without a second mechanism, keep billing the private plans that administer Medicare Advantage and Part D. On September 8 CMS used that second mechanism against eleven durable medical equipment suppliers, and disclosed that four of them were already out of the first.

Two doors into Medicare

Suppliers bill Original Medicare through enrolment, and CMS removes them from it by revocation. Medicare Advantage and Part D are run by private plans, and CMS controls who those plans may pay through the Preclusion List - a roster of individuals and entities whose items, services and prescriptions the plans are barred from paying for.

The gap between those two doors is the story. Four of the eleven had been revoked from Original Medicare and, until this action, remained available to bill the private side.

The cases CMS described

• Florida: one company submitted $18.4 million in catheter claims across two days - $6.1 million on December 15, 2025 covering 500 beneficiaries, and $12.3 million the following day covering 777. A second Florida company, described as a suspected telemarketing scheme, billed for braces that beneficiaries said they never received.
• Texas: $5.5 million in orthotics claims. CMS says six beneficiaries it interviewed stated they did not know the provider, had never heard of the company and did not need the equipment. Nine claims carried service dates after the beneficiary had died.
• New Jersey: a firm billed for thirty-eight separate encounters with beneficiaries who were already deceased. Plan members complained they did not know the provider and had never requested equipment.

The two-day Florida sequence is the kind of pattern that shows up in claims data before it shows up anywhere else: a volume of submissions that no real supply chain could deliver against.

Fraudsters who take advantage of the recently deceased to line their pockets represent a level of indecency that we will not stand for.

Why equipment, and why this keeps happening

Durable medical equipment - catheters, braces, orthotics - is a recurring target because the items are inexpensive individually, shipped rather than administered in person, and ordered on a prescriber's authorisation that the beneficiary may never see. A beneficiary who never ordered anything and never receives anything has no reason to notice a claim. The check on the volume is the payer, not the patient.

This article reports a published federal enforcement action and is not medical, insurance or financial advice.