Medicare Audits: One More Tool Against Equity in Healthcare

As the United States emerged from the COVID-19 Public Health Emergency, the Centers for Medicare & Medicaid Services (CMS) quickly announced an increase in audits of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). The stated reason behind the DMEPOS audits (and all CMS audits) is to assure that CMS is not paying for items that patients do not need, costing the government money in wasteful spending. On the surface this sounds great. For example, why should a person who walks with no problems be supplied with a wheelchair? Or why should a person with a pulled back muscle be issued an expensive back brace designed to help someone with major spinal issues? If this was all that CMS was checking for, audits would be represent great money savings for the American taxpayers.

Unfortunately, these audits go much further. In their zeal to make sure the proper equipment is dispensed to the correct patient, CMS has become rigid and inflexible, and the audits have become more of a witch hunt to discover any potential flaw (or perceived flaw) that will allow them to deny a claim. Although this is true of all categories of DMEPOS, this article will use only one item, diabetic shoes, to illustrate how these audits create barriers to efforts in achieving equity in the healthcare sector.