The six-month moratorium from the Centers for Medicare and Medicaid Services (CMS) on new durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier enrollments is framed as a necessary response to fraud. While true, it is also a reminder of how reliant respiratory care is on a system that is structurally vulnerable.
For years, the durable medical equipment (DME) sector has been a target for fraud and waste. Federal investigations uncovered billions of dollars in improper payments, often tied to unnecessary equipment or phantom billing.1 CMS periodically uses moratoria as an effective blunt tool to slow entries into high-risk categories. This current action reflects continuation and escalation of that approach.
On paper, this rationale is straightforward. Limiting new suppliers reduces the influx of unvetted providers while allowing regulators to strengthen oversight. Importantly, the moratorium does not shutter current suppliers or applicants, and CMS has emphasized that patient access should remain stable.2
DME is integral to respiratory medicine. In-home respiratory medical devices are the mechanisms that bridge patients to living outside the hospital. Any disruption to this fragile lifeline, however indirect, carries consequences.
For patients, the impact may be subtle at first, including delays in delivery or hurdles for approval and limited supplier choice. This tension is pronounced in rural or underserved communities, where access to DME is already fragile. Rural providers face higher operating and supply chain costs with unrealistic reimbursement rates. Policies that force suppliers to absorb loss risks pushing these providers out altogether. Recent legislative efforts have highlighted this vulnerability, emphasizing that without targeted support, rural DME suppliers may be forced to close, leaving patients vulnerable.3 For clinicians, it may appear as an increasing disconnect between hospital-based decision-making and home-based implementation. Respiratory therapists who operate at this transition point face increased pressure and constrained resources.
Historically, DME sector expansion has occasionally followed reimbursement opportunity rather than clinical necessity. When audited, the programs that align with patients’ needs are often jeopardized. The inclusion of suppliers employing respiratory therapists among those subject to increased scrutiny underscores how integral clinical roles can become entangled in problematic structures.2
The intent of the moratorium is justified because unchecked fraud undermines trust and diverts resources. However, it is insufficient because it merely addresses entry into the system rather than offering a way to fix the system itself.
Alternative policy levers may offer a more sustainable balance between access and accountability. The Medicare DMEPOS Competitive Bidding Program, for example, was designed to introduce market-based pricing while requiring suppliers to meet defined quality and financial standards. In doing so, it has demonstrated the potential to reduce costs and limit opportunities for fraud by awarding contracts to vetted suppliers offering competitive bids.3 The program has been controversial though, as it runs the risk of pricing out expensive products like liquid oxygen.
Respiratory care is delivered across a fragmented landscape. Hospital teams, outpatient providers, and DME suppliers often function in parallel rather than as an integrated unit. Accountability and communication are inconsistent, while the metrics that drive reimbursement prioritize volume over meaningful outcomes. In this context, restricting new suppliers may reduce risk for now, but it does not resolve this misalignment.
Let’s imagine what a more durable (no pun intended) solution would look like.
First, respiratory care must be recognized as a longitudinal system, instead of a series of transactions. Equipment delivery is only one step in a continuum that includes education, monitoring, and adjustments over time. Policies focusing on supplier enrollment fail to capture this complexity.
Second, aligning hospital-based decision-making with home-based care delivery while remaining focused on patient preferences and needs would improve accountability and reduce the gaps where both inefficiencies and abuses can occur.
Third, quality must be redefined and include elements of patient-centered care. Success should not be measured by how many devices are delivered but by how effectively they are utilized, how many patients are supported, and number of hospitalizations avoided. Upfront support sets patients up for success rather than penalizing and shaming them for low device use.
Finally, the respiratory care work force must be centered in these conversations. Respiratory therapists bring a unique combination of technical expertise and patient-facing insight, yet their role within the broader care ecosystem remains inconsistently defined or compensated. Any meaningful reform must elevate, not marginalize, this perspective.
The current moratorium signals that the status quo is no longer acceptable. But it also highlights the limits of reactive policy. Slowing the system may reduce harm in the short term. Collaborating to create a respiratory care system that is coordinated, accountable, and resilient enough that it no longer needs blunt instruments to correct its course is vital.
References
1. Office of Inspector General, US Department of Health and Human Services. Health care fraud and abuse control program report fiscal year 2023. Published 2024.
2. Centers for Medicare & Medicaid Services. DME moratorium Q&A. Published February 25, 2026.
3. Feenstra R. Feenstra helps introduce legislation to keep rural durable medical equipment. Feenstra.house.gov.
