# CMS Strengthens Medicare Fraud Controls

A Department of Health and Human Services Office of Inspector General report finds that durable medical equipment fraud schemes targeting Medicare exploit trusted suppliers, physician orders, and beneficiary information rather than breaking through technical defenses. CMS is increasing front-end controls, including prior authorization and additional claim codes. The reports identify no specific solicitation, contract award, or funding amount, but point to potential needs in fraud analytics, identity protection, supplier validation, and beneficiary alerts.

- Medicare contractors and suppliers should review identity checks, physician-order validation, and supplier-integrity controls in light of the fraud methods described.
- For procurement planning, the identified needs suggest potential demand for tools and services supporting fraud analytics, identity protection, supplier validation, and beneficiary alerts; no acquisition or solicitation is specified.
- Organizations serving CMS or Medicare contractors should account for the cited prior-authorization and claim-code controls in relevant operational planning.

**Jurisdictions:** federal
**Industries:** Healthcare
**Topics:** Regulatory Compliance, Cybersecurity
**Published:** October 03, 2026

### Government Entities
- Department of Health and Human Services Office of Inspector General (HHS OIG)
- Centers for Medicare & Medicaid Services (CMS)
- Department of Health and Human Services (HHS)
- Medicare

### Sources
- [
        Medicare fraudsters don’t need to break into the system, they just have to exploit parts designed to be trusted - Federal News Network](https://federalnewsnetwork.com/podcast/federal-drive-with-terry-gerton-podcast/medicare-fraudsters-dont-need-to-break-into-the-system-they-just-have-to-exploit-parts-designed-to-be-trusted) - Federal News Network
- [
        Medicare fraudsters don’t need to break into the system to exploit it - Federal News Network](https://federalnewsnetwork.com/agency-oversight/2026/10/medicare-fraudsters-dont-need-to-break-into-the-system-to-exploit-it) - Federal News Network