Federal health regulators barred a New Jersey durable medical equipment supplier from receiving further Medicare Advantage and Part D payments after finding it billed a Medicare Advantage plan for 38 separate encounters on dates after the beneficiary had already died. The action sits inside a broader enforcement sweep the Centers for Medicare & Medicaid Services announced this week, linking eleven equipment suppliers to more than $3.4 billion in suspected fraudulent billing across 2025 and 2026. For an older reader with a parent, spouse, or sibling recently deceased, the case is a reminder that supply bills and claims can keep arriving under a name that no longer needs care, long after the funeral is over.
Thirty-Eight Encounters Dated After a Death Certificate
CMS said the New Jersey supplier was placed on the agency’s Medicare Preclusion List after investigators identified 38 separate billing encounters tied to one beneficiary, each carrying a date of service that fell after the person had died. The agency paired that finding with member complaints describing equipment the household said it never requested and never received, the same complaint pattern CMS said it found attached to nearly every supplier removed in this round.
CMS detailed the finding in its September 8 enforcement announcement, where CMS Administrator Dr. Mehmet Oz described the pattern across the crackdown as “a level of indecency that we will not stand for,” a description the agency applied to the broader set of suppliers rather than naming the New Jersey firm specifically; CMS did not publicly identify any of the eleven companies.
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A Medicare Advantage Plan Paid the Claims, Not Original Medicare
The distinction CMS drew matters for how the money moved. The agency said the New Jersey company’s 38 disputed encounters were billed to a Medicare Advantage plan, the private coverage option roughly half of Medicare enrollees now choose instead of Original Medicare, rather than to Medicare’s fee-for-service program directly. That is a different pathway than the Florida and Texas cases CMS detailed the same week, where suppliers billed Original Medicare directly and the agency’s own payment-suspension authority stopped roughly $24 million combined before it went out. Because the New Jersey claims moved through a private Advantage plan rather than CMS’s own claims system, the tool available to cut the supplier off was preclusion, not a blocked payment.
The Preclusion List Blocks Future Payments, Not a Criminal Charge
Preclusion is an administrative designation, not a criminal case. Once CMS adds a supplier to its Preclusion List, every Medicare Advantage and Part D plan is barred from paying that supplier going forward, but the listing carries no court finding and triggers no automatic prosecution. CMS has not announced an indictment, conviction, or civil settlement tied to the New Jersey company, and the agency described the billing only as suspected fraudulent activity. Across the eleven suppliers in the sweep, CMS said all had billed for deceased beneficiaries, and four had already been revoked from Original Medicare before shifting their billing to Medicare Advantage plans instead, a pattern the agency said this preclusion effort is now meant to close.
Why an Advantage Plan Can Keep Paying Without CMS Reviewing Every Claim
The mechanics explain how a pattern can reach 38 dates of service before it surfaces. Original Medicare pays claims directly and can suspend a suspicious one before the money moves, which is what stopped the Florida and Texas claims. Medicare Advantage runs differently: CMS pays each insurer a set monthly amount per enrollee, adjusted for that enrollee’s assessed health risk using diagnosis and encounter data the plan reports back to the agency, and the insurer then pays individual suppliers on its own. A supplier billing a plan under a deceased beneficiary’s name is not stopped by a single CMS claims check the way an Original Medicare claim would be; it has to be caught by the plan itself or flagged through a review like the one that produced this preclusion. That structure makes this sweep as much a data-integrity problem as a billing one: fraudulent post-death encounters can sit inside a plan’s records until an audit like this one catches them, rather than triggering an automatic hold the way a live Original Medicare claim would.
What Survivors See on a Medicare Summary Notice, and What Advantage Members Don’t
People with Original Medicare receive a Medicare Summary Notice every four months listing every service or supply billed under their name, what Medicare paid, and what they may owe; Medicare describes the notice as not a bill but a record worth comparing against what was actually received. Medicare Advantage members do not get a Medicare Summary Notice; their plan sends a separate explanation of benefits covering the same ground. An executor or surviving spouse closing out a relative’s accounts can keep receiving these statements for months after a death, since suppliers sometimes bill weeks or months after a date of service, and any line item for equipment dated after that date is worth flagging immediately.
Reporting a Claim Filed After a Date of Death
Medicare directs anyone who spots a suspicious claim, including one dated after a beneficiary’s death, to call 1-800-MEDICARE, and it specifically points Medicare Advantage and Part D members toward the Investigations Medicare Drug Integrity Contractor at 1-877-772-3379, the line built for the kind of plan-billed fraud CMS described in the New Jersey case. Medicare also recommends creating a secure Medicare.gov account, which shows Original Medicare claims as soon as they are processed rather than waiting for the periodic mailed notice, a step useful for anyone monitoring a relative’s account in the months after a death. Having the beneficiary’s Medicare number and the supplier’s name from the billing statement ready before calling speeds up Medicare’s review, according to the agency’s fraud-reporting guidance.
This article was produced with the assistance of AI and reviewed by The Financial Wire editorial team.
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Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
