DME operating in CMS's most consistently active fraud and integrity program.
The engagement
A supplier-standard compliance baseline; defensible medical-necessity files; a repeatable ADR response system; and recovered claims through appeal.
Week 1 — intake: supplier-standard and medical-necessity posture, and exposure. Weeks 2–4 — documentation and coverage-criteria review. Ongoing — pre-bill review and ADR/CERT response.
Regulatory context
DMEPOS sits at the center of the current crackdown. CMS’s nationwide DMEPOS enrollment moratorium (Feb 27, 2026) halts new suppliers; the segment already carries Medicare’s highest error rate at 24.1%; and suppliers must continuously meet roughly 30 supplier standards (42 CFR §424.57). Because UPICs use statistical extrapolation, a small sample of denied claims can become a large demand.
From revenue cycle through audit defense — each shaped to your operation.
The cross-cutting capabilities we bring to DME suppliers — operating in CMS's most active program-integrity environment:
Each service shaped to the specific pressure observed.
Three reasons DME suppliers choose us:
ADR as a system, not a fire drill. Volume-scaled response infrastructure, not heroic overtime.
UPIC contractor methodology understood from both sides. We have worked the contractor side; we know where findings come from.
Competitive bidding math grounded in operations. The contract terms that decide three years of revenue — examined before signature.
Why is DME error so high?
Medical-necessity documentation and supplier-standard compliance are exacting, and a single missing detail denies the claim. DME’s 24.1% error rate is the highest in Medicare.
Does the moratorium affect us?
If you’re enrolling a new DMEPOS location or changing ownership, yes — it’s paused. Existing suppliers keep billing but face heightened review.
How do you handle extrapolation?
We challenge the sample and the methodology and rebuild the medical-necessity record; extrapolated demands are often reduced.
Are you a law firm?
No. We’re expert consultants and licensed investigators who build response systems, not arguments — your counsel makes the argument; we make sure the file supports it. We can serve as testifying experts. Nothing here is legal advice.
Tell us what you are up against. Scoping memo in week one, before any meaningful commitment.