H.R. 8804

119 HR 8804 IH: Medicare Payment Integrity Enhancement Act of 2026
 U.S. House of Representatives
 2026-05-13
 text/xml
 EN
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 I  119th CONGRESS  2d Session  H. R. 8804  IN THE HOUSE OF REPRESENTATIVES   May 13, 2026   Mr. Smucker  introduced the following bill; which was referred to the  Committee on Ways and Means , and in addition to the Committee on  Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned   A BILL
To amend title XVIII of the Social Security Act to authorize the Secretary of Health and Human Services to enter into contracts with recovery audit contractors to perform prepayment reviews under the Medicare program.
1.
Short title
This Act may be cited as the   Medicare Payment Integrity Enhancement Act of 2026  .
2.
Authorizing recovery auditor contractors to conduct prepayment reviews under Medicare
(a)
In general
Section 1893(h) of the Social Security Act ( 42 U.S.C. 1395ddd(h) ) is amended—
(1)
in paragraph (1)—
(A)
in matter preceding subparagraph (A)—
(i)
by striking  and recouping  and inserting  , recouping ; and
(ii)
by striking  title.  and inserting  title, and conducting prepayment review of claims for payment under this title. ;
(B)
in subparagraph (A), by inserting  except in the case of prepayment review of claims for payment under this title,  before  payment shall be made ;
(C)
in subparagraph (B)—
(i)
by inserting  except in the case of prepayment review of claims for payment under this title,  before  from such amounts ; and
(ii)
in clause (ii), by striking  and  at the end;
(D)
in subparagraph (C), by striking the period at the end and inserting  ; and ; and
(E)
by inserting after subparagraph (C) the following new subparagraph:
(D)
payment to such a contractor for prepayment review of claims for payment under this title shall be made in amounts determined under a methodology established by the Secretary that—
(i)
takes into account the amount of improper payment that such contractor prevented from being paid under this title; and
(ii)
incentivizes the timely and accurate prevention of such improper payments, without a disproportionate focus on particular types of claims.
 ;
(2)
in paragraph (3), by inserting  , and not later than 1 year after the date of the enactment of the  Medicare Payment Integrity Enhancement Act of 2026 , in the case of contracts relating to the prepayment review of claims for payment under this title  after  under part C or D ;
(3)
in paragraph (7)—
(A)
by inserting  or the prevention of part or all of a payment under this title based on a prepayment review of a claim for payment  after  individual or entity ; and
(B)
by inserting  or prepayment review  after  such overpayment ;
(4)
in paragraph (8), by inserting  (and, to the extent that contracts under this subsection require prepayment review of claims for payment under this title, on the performance of such contractors with respect to such prepayment reviews)  after  recouping overpayments ; and
(5)
by adding at the end the following new paragraph:
(11)
Funding for prepayment review
For purposes of making payment to recovery audit contractors for prepayment review of claims for payment under this title, as described in paragraph (1)(D), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841, in such proportion as the Secretary determines appropriate based upon the relative amount of improper payments that such contractors prevented from being paid under parts A and B, of such sums as the Secretary determines necessary, to the Centers for Medicare & Medicaid Services Program Management Account.
 .
(b)
Regulations
Not later than 1 year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue such rules as are necessary to implement the amendments made by subsection (a). Such rules shall include—
(1)
a description of the methodology that the Secretary shall use as the basis for making payment to recovery audit contractors for the prepayment review of claims for payment under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ); and
(2)
a description of the methodology that the Secretary shall use to calculate savings to the Medicare program under such title XVIII generated by such prepayment reviews.