Ryan Bullock
Aeroflow Health’s Ryan Bullock had an eventful summer in what has been a pivotal year for the durable medical equipment (DME) industry.
Bullock is Aeroflow Health’s chief strategy officer and recently became chairman of the board for the American Association for Homecare (AAHomecare). That appointment came as Medicare competitive bidding stayed on track to restart with Round 2028, and the Centers for Medicare & Medicaid Services (CMS) was ultra-focused on eliminating fraud, waste and abuse across a number of home-based healthcare segments, including DME.
HME Business asked Bullock to wear both hats — as AAHomecare’s chair and as an Aeroflow Health leader — in answering questions on what the DME industry can expect heading into the remainder of 2026.
Policy focuses for the rest of the year
HME Business: The first half of 2026 was dominated by CMS’s focus on reducing Medicare fraud and abuse. What policy topics do you expect to significantly impact the rest of 2026?
Ryan Bullock: I anticipate that fraud and abuse will remain a significant focus through the second half of the year. CMS has shown that combating fraud and maintaining program integrity are among its long-term priorities, and those are priorities we support as an industry.
That said, I see the conversation evolving into a larger question: How do we strengthen program integrity without damaging the infrastructure that delivers medically necessary care to Medicare beneficiaries?
The next phase should be about making oversight more effective without creating unnecessary burdens for compliant providers through modernizing audit processes, creating greater consistency in how claims are reviewed, and leveraging advanced analytics and AI [artificial intelligence] to identify suspicious activity sooner. In short, oversight that is smarter and more targeted, not simply more oversight.
HME Business: CMS has been targeting fraud in multiple Medicare areas, including home health and hospice providers, in addition to DME suppliers. Why is fraud enforcement being so specifically and energetically targeted? Do you believe CMS’s anti-fraud campaign for DME is reasonable and proportionate given Medicare spending for DME?
Bullock: Fraud directly harms the patients we exist to serve, and uncovering it is paramount to preserving the integrity of the Medicare DME benefit. When bad actors exploit the system, it erodes trust, tightens access, and drives up costs for everyone. If our industry doesn’t take a strong, visible stance on this, we cede the narrative to those who would rather paint all HME suppliers as suspect, and that is unacceptable.
At the same time, the hyper-focus on DME is not proportionate. DME represents less than 2% of total Medicare spending, yet it draws an outsized share of enforcement and audit activity. Right now, quality providers are bearing the brunt of regulatory scrutiny while other, much larger areas of healthcare spending do not face the same intensity of review.
The end of the new provider enrollment moratorium
Bullock: The moratorium expired as scheduled on August 27, and Medicare is once again accepting enrollment applications for the affected supplier categories. We appreciated CMS’s decision to let the moratorium run its course rather than extend it. This was an issue AAHomecare raised directly with the agency and the administration.
To be clear, the industry is not asking for less scrutiny of fraud, waste and abuse. New applicants should expect, and honest suppliers should welcome, rigorous screening. The bigger challenge is finding better ways to stop fraud while preserving patient access. We support stronger provider screening, smarter data-driven oversight, and targeted enforcement that focuses on bad actors, not additional burdens for providers who are already doing things right.
HME Business: This is also a midterm election year. If current regulatory priorities continue in this same direction past the end of this year, what would the impact be on Medicare DME suppliers?
Bullock: Right now, regulators are enacting a blunt, one-size-fits-all enforcement, rather than clearer, more targeted guidelines. If this continues, we will start to see negative impacts on the quality of products and services that HME [home medical equipment] suppliers can provide, and eventually a decrease in access to medical equipment and resources for patients. This is due to the current regulatory framework forcing honest providers to operate at a race-to-the-bottom model. Suppliers who are doing everything right are being pulled away from patient care to handle claims that have either already passed prior audits or that they are already in compliance.
A right and real path forward
HME Business: You’re the new chairman of AAHomecare. What can you tell us about AAHomecare’s policy priorities for the rest of 2026?
Bullock: This year, we’re prioritizing proactive policy shaping by engaging with lawmakers and federal agencies to create a regulatory framework that ensures oversight efforts are proportionate across all sectors of healthcare. We’ll also be continuing the state-level advocacy that AAHomecare has previously prioritized, along with navigating structural changes, such as AI and data utilization.
HME Business: How do you believe CMS could most reasonably and fairly balance the need to protect the Medicare trust fund with protecting beneficiary access to medically necessary DME and related services?
Bullock: CMS should adopt a forward-looking, technology-enabled approach to fraud prevention that reduces administrative burden on compliant providers while strengthening oversight of bad actors. This includes standardizing audit processes to address systemic inefficiencies and inconsistencies that undermine program integrity. The current audit framework is causing duplicative reviews and highly variable outcomes driven by auditor discretion that is increasing disruption to DME suppliers.
CMS should also shift program integrity efforts to the front end of the claims process by leveraging AI and predictive analytics to flag irregular incoming claims prior to payment, [which] would enable CMS to proactively identify suspicious activity and prevent improper payments.
