GUARD Veterans’ Health Care Act
Sponsored By: Representative Doggett
In Committee
Summary
Gives the Department of Veterans Affairs new power to recover payments from Medicare Advantage and Medicare Part D plans for care the VA provides. It would also strengthen VA’s ability to bill third-party insurers and tortfeasors and set firm timelines, interest, and penalties to enforce collections.
Show full summary
- Veterans and families: VA-provided care that falls under an enrollee’s MA or Part D coverage would trigger reimbursement to the VA. This change would apply to plan years beginning on or after Jan. 1, 2026.
- Medicare Advantage and Part D plans: MA organizations and Part D sponsors would have to reimburse the VA for covered items and drugs even if the plan normally requires extra documentation or utilization management.
- Third-party insurers and tortfeasors: Third parties must pay a clean VA claim within 45 days or face Treasury-rate interest and a 45-day cure period. Civil penalties for willful nonpayment can reach $50,000 per claim, adjustable for inflation, and third parties must promptly share beneficiary information with the VA.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
Faster VA reimbursements and fines for late payers
The bill would set firm timelines for insurers and other payers to answer VA claims. They would have 45 days to pay a clean claim or give a written refusal; if VA sends more info within 45 days, the payer would have 15 more days to pay. Interest would apply to late amounts at the Treasury rate, and refund requests would be limited to 18 months after VA received the money. Payers would have to report within 30 days when they know someone received VA benefits, could not force non‑VA forms, and could not release settlements before paying VA. For violations, VA could charge daily fines, and for willful failures seek the greater of triple the claim or up to $50,000 per claim (inflation‑adjusted), after written notice and 30 days to pay; the United States could also sue for double damages.
Broader VA recovery from insurers and torts
The bill would let VA recover costs from more sources when it treats a non‑service‑connected condition. VA could seek payment from people who caused the injury and from insurance that pays medical bills outside a health plan, like medical payments or underinsured motorist coverage. A clean claim would mean one that needs no extra information, and non‑service‑connected would include an aggravation of a service‑connected condition. Most recovery actions would need to start within six years of the last day of care; tort money‑damage suits would have a three‑year window from when the claim accrues. Recoveries would not be limited by private fee schedules or reimbursement caps, and VA could set rules or instructions to carry this out.
Medicare plans would repay VA for your care
If enacted, when VA gives a Medicare‑covered item or service to someone in Medicare Advantage or a Medicare drug plan, the plan would have to reimburse VA for the covered part, regardless of extra plan paperwork or approvals. This would cover hospital and clinic care, prescriptions, devices, lab tests, and some post‑acute or long‑term care. Money would go to the VA Medical Care Collections Fund and be recovered using VA’s existing third‑party procedures. This would start for plan years that begin on or after January 1, 2026. Medicare law would be updated to reference this VA repayment rule.
Sponsors & CoSponsors
Sponsor
Doggett
TX • D
Cosponsors
Murphy
NC • R
Sponsored 6/23/2025
Takano
CA • D
Sponsored 6/23/2025
Schweikert
AZ • R
Sponsored 6/23/2025
Joyce (PA)
PA • R
Sponsored 6/23/2025
Landsman
OH • D
Sponsored 6/24/2025
Roll Call Votes
No roll call votes available for this bill.
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