CAT Act of 2025
Sponsored By: Representative Harder, Josh [D-CA-9]
Introduced
Summary
More transparency and due process for Medicare payment suspensions. The CAT Act of 2025 would tighten when and how the Secretary can pause Medicare and related payments by requiring advance notice, regular updates, an independent appeals path, and yearly reporting.
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- Providers and suppliers would get detailed notice at least 30 days before a payment suspension listing each credible allegation, the date, and the basis of the allegation such as a fraud hotline tip, data mining, or audit findings. They would receive updates every 30 days and an independent appeal process the Secretary must establish within 180 days of enactment. If CMS fails to provide required information payments must resume and owed amounts paid with interest.
- Patients and access to care would face less risk of long interruptions because investigations and suspensions could not extend past 180 days unless there is good cause to continue. The bill highlights that long suspensions can harm access to services.
- CMS and oversight would see new reporting and process rules. The Secretary must send Congress an annual report starting after fiscal year 2025 showing the number of suspensions, the basis for each, average suspension and investigation durations, and time to reinstatement. The changes apply only to investigations initiated after enactment under the named statutory authorities.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 3 benefits, 0 costs, 1 mixed.
Independent appeals for suspended providers
If enacted, the Secretary would have to set up an independent appeals process within 180 days. Providers and suppliers who get a payment suspension would be able to appeal and get a timely decision. The Secretary would have to consult Medicare, Medicaid, and CHIP providers when making the process. This requirement would apply to investigations started after enactment.
Limits and notice for payment suspensions
If enacted, CMS would generally have to limit investigations and payment suspensions to 180 days unless there is documented good cause to extend. CMS would have to give detailed notice at least 30 days before a suspension and update the provider at least once every 30 days during the suspension. If CMS fails to provide required notice or updates, CMS would have to resume payments and pay withheld amounts plus interest. CMS would also send Congress an annual report starting with fiscal year 2025, due within 180 days after each fiscal year ends.
Rules apply only to future investigations
If enacted, the bill would apply only to investigations that start after the date of enactment. Investigations that began before enactment would not be covered. This reduces the chance that past investigations would be changed retroactively.
What counts as a credible allegation
If enacted, the bill would define what may count as a "credible allegation of fraud." The listed bases include a fraud hotline tip (as the Secretary defines), "mere error" (as defined by the Secretary), and audit-found billing errors that are human error. This would change when CMS or its contractors can start investigations or suspend payments for providers.
Sponsors & CoSponsors
Sponsor
Harder, Josh [D-CA-9]
CA • D
Cosponsors
Rep. Kim, Young [R-CA-40]
CA • R
Sponsored 12/18/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov