OIG urges CMS to crack down on DME fraud in Medicare Advantage, citing improper payments

The HHS Office of Inspector General is pressing CMS and Medicare Advantage organizations to intensify efforts to prevent durable medical equipment fraud. The OIG's call follows audit findings of widespread improper payments linked to lax oversight of DME suppliers operating within MA networks. The report signals that CMS may soon require MA plans to implement stricter supplier credentialing and claims validation, which could impact prior authorization timelines and documentation requirements for DME orders placed through MA plans. Practices should prepare for more stringent documentation requests from MA plans for DME referrals, especially for high-cost items.