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Description
Regulatory oversight from CMS is intensifying across multiple healthcare segments, with DMEPOS suppliers, wound care providers, and diagnostic testing/laboratory entities receiving particularly close attention. Many organizations are experiencing more frequent audits, rising overpayment determinations, and growing volumes of administrative appeals—often fueled by changing contractor positions and an evolving enforcement lens. Staying ahead of how this scrutiny is showing up in day-to-day audits and appeal decisions is increasingly important for controlling compliance risk and operational disruption.
This webinar offers a grounded, practice-focused review of the CMS trends currently shaping enforcement activity in DMEPOS, wound care, and diagnostic testing and laboratory services. Based on real audit matters, enforcement activity, and Medicare appeals handled by healthcare counsel in the past 12 months, the program explains how coverage rules, documentation expectations, and supplier-standard requirements are being interpreted and applied in current reviews. The emphasis is on what providers are encountering in the field—not abstract guidance—spotlighting the recurring reasons behind denials and overpayment findings.
The session begins by mapping the broader pattern of CMS scrutiny across these service lines, highlighting the themes that continue to surface in audit determinations and in the outcomes of administrative appeals. Attendees will gain clarity on where organizations most commonly encounter friction and how those issues are being challenged and resolved through the appeals process. The program then transitions into service-line specific observations. For DMEPOS suppliers, the discussion focuses on persistent risk areas such as medical necessity determinations, proof-of-delivery disputes, refill and quantity limitations, and compliance with enrollment and supplier standards. For wound care providers, the webinar reviews audit and appeal challenges linked to treatment protocols, documentation sufficiency, frequency of services, and medical necessity assessments. For diagnostic testing and laboratories, the program analyzes common findings related to test ordering, documentation support, billing practices, and contractor interpretations that have led to adverse outcomes—while also addressing Medicare lab reimbursement 2026 considerations tied to the Clinical Laboratory Fee Schedule (CLFS) 2026 annual update, PAMA payment reductions 2026, the CLFS data reporting period Feb 1–Apr 30, 2026, Private payor rate reporting (PAMA), and how Advanced Diagnostic Laboratory Tests (ADLT) and Clinical Diagnostic Laboratory Tests (CDLT) are being reviewed in practice. Throughout the webinar, speakers share practical lessons and examples drawn from recent Medicare appeals. Attendees will hear how CMS contractors and adjudicators are responding to provider challenges and what steps can strengthen a provider’s position during audits and in the earliest stages of appeal. The webinar closes with a forward-looking view of likely CMS priorities based on recent enforcement and appeal activity, including which issues appear positioned to remain in focus, where scrutiny may expand, and how providers and suppliers can prepare now. Participants will leave with a clearer understanding of current enforcement patterns and practical guidance for navigating audits and regulatory scrutiny with confidence. This webinar is designed for DMEPOS suppliers, wound care providers, diagnostic laboratories, compliance professionals, executives, and counsel seeking a timely, real-world perspective grounded in recent enforcement experience.
CMS’s evolving enforcement strategies are driving heightened scrutiny of DMEPOS suppliers, wound care providers, and diagnostic laboratories. This webinar delivers an inside look at where CMS audits and enforcement efforts have focused over the past 12 months in these areas and highlights the key hot-spot issues putting associated providers and suppliers at risk.
Learning Objectives
After attending this session, participants will be able to:
- Identify recent CMS audit and enforcement trends affecting DMEPOS, wound care, and diagnostic testing/laboratory providers.
- Recognize common issues driving denials, overpayments, and adverse appeal outcomes.
- Apply practical strategies for responding to audits and navigating Medicare appeals.
Areas Covered
- Recent CMS audit and enforcement trends in DMEPOS, wound care, and labs: hot-spot issues driving scrutiny in these areas
- Common denial and overpayment themes in these areas
- Practical audit and appeal considerations in these areas.
Who Should Attend
- Providers & Suppliers (DMEPOS, wound care, and diagnostic testing/labs)
- Executives & Operational decision-makers
- Compliance Officers
- Billing/Revenue Cycle Teams
- In-house Healthcare Counsel
- Outside Healthcare Counsel.
Speaker
For over 20 years, Knicole has maintained a healthcare litigation practice, concentrating on Medicare and Medicaid litigation, healthcare regulatory compliance, administrative law, and regulatory law. She understands the intricate Medicare and Medicaid payment system, the unique business of healthcare providers, the overlay of federal and state Medicare and Medicaid rules and regulations, and the actions of state agencies that affect how healthcare entities operate. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards.
Knicole has successfully obtained federal injunctions in numerous states, which allowed healthcare providers to remain in business despite the state or federal laws’ allegations of healthcare fraud, abhorrent billings, and data mining. Across the country, Knicole frequently lectures on healthcare law, the impact of the Affordable Care Act, and regulatory compliance for providers, including physicians, home health and hospice, dentists, chiropractors, hospitals, and durable medical equipment providers. She is a weekly panelist on RACMonitor, as a national expert on Medicare and Medicaid audits. Before joining Practice, Knicole was Co-Chair/Managing Partner of the Healthcare Practice with Gordon & Rees and served as North Carolina Assistant Attorney General in the Health and Public Assistance Section, where she gained a thorough understanding of the Medicaid system that informs her practice today.