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HR8804119th CongressWALLET
Medicare Payment Integrity Enhancement Act of 2026
Sponsored By: Representative Smucker, Lloyd [R-PA-11]
Introduced
Summary
This bill would authorize Medicare to use _prepayment reviews by recovery audit contractors_ to stop improper payments before claims are paid. It also creates a dedicated funding route and payment rules that reward prevented improper payments without overemphasizing specific claim types.
Show full summary
- Medicare program: Would let CMS fund and run prepayment reviews aimed at preventing improper payments before Medicare pays claims. Funding would come from transfers from the Hospital Insurance (Part A) and Supplemental Medical Insurance (Part B) trust funds to the CMS Program Management Account in proportions set by the Secretary.
- Providers and suppliers: Claims could be reviewed before payment rather than relying only on postpayment recoupment, changing when and how Medicare evaluates billed services.
- Recovery audit contractors and CMS operations: RACs would be authorized to perform prepayment reviews and be paid under a Secretary-established methodology that accounts for prevented improper payments. The Secretary must issue regulations within 1 year describing the payment method and how savings from prepayment reviews will be calculated, and contracts must conform to the new rules within 1 year.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Medicare prepayment audits for claims
If enacted, this bill would let the HHS Secretary hire recovery audit contractors to check some Medicare claims before Medicare pays them. The Secretary would set a payment method for those contractors that counts the improper payments prevented and avoids over‑focusing on particular claim types. The bill would let HHS transfer money from the Hospital Insurance and Supplementary Medical Insurance trust funds to a CMS account to pay contractors. HHS would have to issue rules and update contracts within one year. This would aim to reduce improper Medicare payments and save program money.
Sponsors & CoSponsors
Sponsor
Smucker, Lloyd [R-PA-11]
PA • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov