CMS’ six-month moratorium on Medicare enrollment for certain durable medical equipment, prosthetics, orthotics and supplies vendors is the latest move in its broader fraud crackdown, but musculoskeletal leaders are divided on what it will mean for care delivery. While some view the policy as necessary upstream enforcement to curb long-standing abuse in orthotics and equipment billing, others warn it reflects deeper oversight failures and could unintentionally disrupt legitimate innovation and patient access.
Here’s how leaders are assessing the balance between fraud prevention and continuity of MSK care:
Question: What is your reaction to CMS’ decision, and do you anticipate any impact on orthopedic and spine practices or patient access?
Editor’s note: Responses have been lightly edited for clarity and length.
Jeffrey Carlson, MD. President at Orthopaedic & Spine Center (Newport News, Va.): I think a nationwide moratorium on new Medicare enrollment for DMEPOS suppliers raises a concern for CMS’ ability to vet suppliers. I think it will only delay legitimate suppliers from providing good medical care. I would expect that the new suppliers would be supplying information about their organizations that CMS should be able to evaluate for determination of legitimacy. If not, why go through the application process? There should be enough bandwidth in CMS to evaluate current suppliers and add new suppliers. It would seem that the evaluation would look very similar.
Edward DelSole, MD. Orthopedic Spine Surgeon at Keystone Spine & Pain Management Center (Wyomissing, Pa.): CMS’ DMEPOS moratorium is less a fraud crackdown than a confession. The Office of Inspector General has flagged rampant DME fraud since 1998, nearly three decades of documented failure. Rather than fix its own oversight apparatus, the agency now freezes enrollment and signals to clinicians that billing for legitimate medical services makes them suspect.
This fits a pattern. TEAM, ACCESS and the Ambulatory Specialty Model are steadily dismantling fee-for-service reimbursement. Each new restriction either pushes Medicare beneficiaries toward managed Advantage plans, administered by private payers who profit by denying care, or drives physicians out of traditional Medicare entirely.
The fraud problem in DMEPOS is real, but the solution isn’t a moratorium on new suppliers. A rational strategy should start with the competent stewardship of public dollars, something CMS has failed to deliver for thirty years while the bill compounded.
David Kalainov, MD. Medical Director of Orthopedics at Northwestern Memorial Hospital (Chicago): There are several suppliers of DMEPOS and numerous existing products covered by CMS. There will unlikely be an impact on existing product use and coverage. However, the six-month moratorium will impact new products in the pipeline within existing companies and DMEPOS products in development by startup companies. Investors will be reluctant to invest in a startup company working on a DMEPOS with uncertain future reimbursement. CMS coverage of DMEPOS typically drives the decision for coverage by commercial insurers.
Morgan Lorio, MD. Spine and Hand Surgeon at Advanced Orthopedics and Pain Management (Orlando, Fla.): This restriction is unlikely to materially affect clinical practices. It represents an upstream effort to address supplier-side fraud that can scale rapidly and, through ownership cycling, be redeployed even after revocation. DME fraud can industrialize through digital documentation fabrication that is difficult to detect at the routine claim-edit level. Absent enrollment tightening, enforcement risks becoming a shell game, with operators closing one entity only to reopen under a new tax ID or ownership structure.
High-reimbursement items such as orthotic bracing and mobility scooters have long been vulnerable to aggressive marketing and billing patterns, making them predictable areas for regulatory attention. This is upstream gatekeeping, not a reduction in clinical care. I support this effort to rein in waste and protect taxpayer resources.
Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach (Calif.) Lakewood Orthopedic Institute: From an orthopedic spine perspective, CMS’ six-month moratorium on new DMEPOS enrollment appears to be a targeted fraud-control measure, not a restriction on physician practices. The cited data, including high revocation rates and concentrated high-risk orthotic billing among certain suppliers, suggests a legitimate program integrity issue. Because the moratorium does not apply to physician offices, hospitals or ASCs whose primary function is not supplying DMEPOS, most orthopedic and spine practices providing braces as part of comprehensive care should not be directly affected.
Impact may emerge at the margins, particularly in rural or underserved areas with limited reputable suppliers or if enforcement creates delays in legitimate claims processing. In spine care, orthoses are often time-sensitive and tied to acute injury or postoperative stabilization, so distribution or reimbursement bottlenecks could disrupt continuity of care. Addressing fraud is essential, but success will depend on balancing stronger safeguards with preserving access to medically necessary spine services.
Joseph Zuckerman, MD. Chair of Orthopedic Surgery at NYU Langone Health (New York City): Fraud within the CMS system is clearly a problem and needs to be identified, corrected and prevented going forward. The described approach may help identify fraud, but it will certainly negatively impact those CMS patients who truly require the care and services provided. In my opinion, the measures are too broad and generalized.
