H.R. 8871

119 HR 8871 IH: DME Scammer Prevention Act of 2026
 U.S. House of Representatives
 2026-05-19
 text/xml
 EN
 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 I  119th CONGRESS  2d Session  H. R. 8871  IN THE HOUSE OF REPRESENTATIVES   May 19, 2026   Mr. Bean of Florida  introduced the following bill; which was referred to the  Committee on Energy and Commerce , and in addition to the Committee on  Ways and Means , 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 promote Medicare program integrity with respect to certain medical equipment and supplies.
1.
Short title
This Act may be cited as the   DME Scammer Prevention Act of 2026  .
2.
Promoting Medicare program integrity with respect to certain medical equipment and supplies
(a)
Electronic submission of claims by all providers and suppliers
Section 1862(h) of the Social Security Act ( 42 U.S.C. 1395y(h) ) is amended—
(1)
in paragraph (1)(A)(ii), by striking  the entity  and inserting  except in the case of claims for specified items (as defined in paragraph (3)), the entity ; and
(2)
by adding at the end the following new paragraph:
(3)
For purposes of paragraph (1)(A)(ii), the term  specified items  means medical equipment and supplies (as defined in section 1834(j)(5)) furnished on or after January 1, 2027, that are included on the Master List described in section 1834(a)(23).
 .
(b)
Submission of claims within 90 days
Section 1842(b)(3) of the Social Security Act ( 42 U.S.C. 1395u(b)(3) ) is amended—
(1)
in subparagraph (B), in the flush matter following clause (ii), by inserting  (or, in the case of claims for applicable items, the period ending 90 days after such date of service)  after  date of service ; and
(2)
in the flush matter following subparagraph (L)—
(A)
in the sixth sentence—
(i)
by inserting  or end of the 90-day period specified in such subparagraph (as applicable)  after  close of the following calendar year ; and
(ii)
by inserting  or end of such period (as applicable)  after  close of such year ;
(B)
in the ninth sentence, by inserting  or 90-day period (as applicable)  after  1 calendar year period ; and
(C)
by adding at the end the following new sentence:  For purposes of subparagraph (B), the term  applicable items  means specified items (as defined in section 1862(h)(3)), other than any such item that is included on the Required Face-to-Face Encounter and Written Order Prior to Delivery List described in section 410.38(c)(8) of title 42, Code of Federal Regulations (or a successor regulation) or on the Required Prior Authorization List described in section 414.234(c)(1) of title 42 of such Code (or a successor regulation) or for which payment is made on a monthly rental basis. .
(c)
Report
(1)
In general
Not later than January 1, 2030, the Comptroller General of the United States shall submit to Congress a report on the technology used by medicare administrative contractors to screen claims for specified items to identify errors or indicators of potential waste, fraud, or abuse. Such report shall include, with respect to the 1-year period beginning on January 1, 2027—
(A)
an examination of—
(i)
the total number of such claims submitted during such period for which payment was initially denied on the basis of such screening technology; and
(ii)
the total number of claims so denied for which payment was ultimately made; and
(B)
an examination of the extent to which the use of such screening technology (taking into account the amendments made by subsections (a) and (b)) assists in the identification of—
(i)
suspicious claims or aberrant billing practices that may be indicative of improper payments; and
(ii)
the basis of claims denials.
(2)
Definitions
In this subsection:
(A)
Medicare administrative contractor
The term  medicare administrative contractor  has the meaning given such term in section 1874A(a)(3) of the Social Security Act ( 42 U.S.C. 1395kk–1(a)(3) ).
(B)
Specified items
The term  specified items  has the meaning given such term in section 1862(h)(3) of the Social Security Act, as added by subsection (a).