CAT Act of 2025
Sponsored By: Representative Harder (CA)
Introduced
Summary
This bill would require greater transparency and due process when Medicare payments are suspended during fraud investigations. It would cap most suspensions at 180 days, add 'mere error' and audit-found billing mistakes as possible triggers, require 30-day pre-suspension notice and monthly updates, and create an independent appeals process.
Show full summary
- Providers would get detailed notice at least 30 days before a suspension, monthly lists of findings and an anticipated timeline, and a chance to ask CMS questions. If CMS fails to provide required disclosures payments must resume immediately and withheld amounts must be paid with interest.
- CMS investigations would generally be limited to 180 days unless the Secretary finds good cause to extend. The bill also broadens the bases for action to include fraud hotline tips, data mining patterns, mere errors, and billing mistakes found in audits.
- Congress would get annual reports starting after fiscal year 2025 showing the number and basis of suspensions, average suspension and investigation durations, and average time to reinstate payments.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 1 costs, 0 mixed.
Stronger notice and time limits
If enacted, the Secretary would have to tell Medicare, Medicaid, and CHIP providers about each credible allegation at least 30 days before pausing payments. During a suspension, the Secretary would give updates at least every 30 days with findings, a timeline, and an opportunity to ask CMS questions. Pauses would generally end after 180 days unless the Secretary finds good cause to extend the suspension. If required notice or updates are not provided, payments would resume immediately and withheld amounts would be paid with interest.
Independent appeals for suspensions
If enacted, the Secretary would have to set up an independent appeals process for providers who get a payment suspension notice. The appeals process would be created within 180 days after enactment and must be developed with input from relevant providers and stakeholders. The process would let affected Medicare, Medicaid, and CHIP providers appeal suspensions and receive a timely resolution.
Broader reasons that can trigger probes
If enacted, the bill would expand what counts as a "credible allegation of fraud." The list would include a hotline tip, what the Secretary calls a "mere error," and billing mistakes found in audits that are due to human error. These broader categories would let officials consider more issues as grounds for investigations or payment suspensions.
Applies only to future investigations
If enacted, these changes would apply only to investigations that start after the law is enacted. The bill would not change rules for investigations that began before enactment. It specifically covers investigations under the relevant Medicare, Medicare drug benefit (Part D), and Medicaid authorities cited in the bill.
Sponsors & CoSponsors
Sponsor
Harder (CA)
CA • D
Cosponsors
Kim
CA • R
Sponsored 12/18/2025
Roll Call Votes
No roll call votes available for this bill.
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