Medicare’s Dead Patients Expose a Living Accountability Failure -By Fransiscus Nanga Roka

Bill should never be creating medical bills new for dead patient – TMC The scandal over suppliers charging Medicare for services performed after beneficiaries passed away propels scrutiny both on potential fraudsters and controls designed to prevent them.

On September 8, 2026, CMMS announced that it was taking measures against 11 equipment suppliers responsible for estimated fraudulent billing of over $3.4 billion during calendar years (CY) 2025–2026. They were added to CMS’s Preclusion List, which stops future Medicare Advantage and Part D payments based on work with the HHS’s inspector general. This figure is indicative of suspect billing, not proven taxpayer losses or formal convictions.

CMS’s examples are extraordinary. One Florida supplier filed nearly $18.4 million in catheter claims within two days. Investigators learned the Texas company for which it submitted about $5.5 million in orthotics claims was out of business at its listed address. Those payments were instead blocked because of the payment suspensions, CMS says. All 11 suppliers had billed for beneficiaries dead already, and none had filed claims prior to 2025. Always:Four had previously been disenrolled from Original Medicare before converting to Medicare Advantage billing.

And that last detail is the indictment, from institutions. Block one payment channel from a supplier does not mean you are completely protected if another channel is available. Fragmented control reduces enforcement to an incentive to move.

The hypothesized mechanism circumvents the danger of separation: a “claim” can appear formally competent without ever showing that a patient had REQUIRES, ordered, or received anything. Substitutes for verified care: Beneficiary identifiers, billing credentials and plausible product codes Prevention has to re-establish a link between the invoice and the human being.

The other thing that Washington must resist is to exaggerate its own victory. CMS And Medicare Fraud, CMS saves another $42 billion for medicare fraud prevention in fiscal 2025 This is a more general statement of the agency, and not 11 suppliers compensated or six months of proof. Instead, Congress should require efforts to be made to review calculations distinguishing between blocked claims, payouts and predicted averted spending.

There will also be no reason to conveniently combine separate cases in several countries into an international conspiracy charged together by prosecutors. Connections require evidence. Broad generalizations can hide the actual problem — winning convictions against those defendants, transactions and losses investigators have truly proven.

Five reforms should follow.

One is the need for CMS and private Medicare plans to provide actionable supplier-risk information in a timely manner. Revocation requires a coordinated review across payment channels, if the governance is appropriate and not treated as an administrative silo.

Second, there should be proportionate verification before payment of high-risk equipment claims: checks of death records, authenticated clinical orders and evidence that the equipment was actually delivered. While these controls should be accompanied by the patient confirmation, they must not shift the burden of policing the program onto frail beneficiaries.

Third, investigate beneficial owners, joint bank accounts, addresses and billing middlemen. If the same controllers are quickly back with a different name, closing a corporate shell really does little.

Fourth, to be useful, analytics must point out which patterns are suspicious for investigation by people responsible. For example, an algorithmic score is not equivalent to a conviction. Suppliers need simple rationales and significant scrutiny; patients need a continuity of key devices for critical treatments while the litigation is resolved.

Fifth, enforcement should trail leads of money from the supplier to a knowingly facilitating individual or entity and (as warranted by evidence) all the way through any foreign recipients. Very few jurisdictions do happily announce the total of seized overseas assets but legally tracing your assets, cooperating with other nations and recovering more is well past a near-zero baseline with an eye for big headlines.

The agency subsequently put payments on hold and praised the decision made by CMS. But real, durable success hinges upon responding to the harder one: why will suppliers who didn’t get into the first Medicare channel chase payment through another?

Wong The public should demand a system that filters out bogus care without obstructing legitimate healthcare. The dead do not provide profit that the living should suffer collateral damage for in the war on drugs.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and Managing Partner Law Firm Victorious Indonesia