HouseH.R. 8804119th Congress
Medicare Payment Integrity Enhancement Act of 2026
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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8804 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 8804
To amend title XVIII of the Social Security Act to authorize the
Secretary of Health and Human Services to enter into contracts with
recovery audit contractors to perform prepayment reviews under the
Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 13, 2026
Mr. Smucker introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, 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 authorize the
Secretary of Health and Human Services to enter into contracts with
recovery audit contractors to perform prepayment reviews under the
Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Payment Integrity
Enhancement Act of 2026''.
SEC. 2. AUTHORIZING RECOVERY AUDITOR CONTRACTORS TO CONDUCT PREPAYMENT
REVIEWS UNDER MEDICARE.
(a) In General.--Section 1893(h) of the Social Security Act (42
U.S.C. 1395ddd(h)) is amended--
(1) in paragraph (1)--
(A) in matter preceding subparagraph (A)--
(i) by striking ``and recouping'' and
inserting ``, recouping''; and
(ii) by striking ``title.'' and inserting
``title, and conducting prepayment review of
claims for payment under this title.'';
(B) in subparagraph (A), by inserting ``except in
the case of prepayment review of claims for payment
under this title,'' before ``payment shall be made'';
(C) in subparagraph (B)--
(i) by inserting ``except in the case of
prepayment review of claims for payment under
this title,'' before ``from such amounts''; and
(ii) in clause (ii), by striking ``and'' at
the end;
(D) in subparagraph (C), by striking the period at
the end and inserting ``; and''; and
(E) by inserting after subparagraph (C) the
following new subparagraph:
``(D) payment to such a contractor for prepayment
review of claims for payment under this title shall be
made in amounts determined under a methodology
established by the Secretary that--
``(i) takes into account the amount of
improper payment that such contractor prevented
from being paid under this title; and
``(ii) incentivizes the timely and accurate
prevention of such improper payments, without a
disproportionate focus on particular types of
claims.'';
(2) in paragraph (3), by inserting ``, and not later than 1
year after the date of the enactment of the Medicare Payment
Integrity Enhancement Act of 2026, in the case of contracts
relating to the prepayment review of claims for payment under
this title'' after ``under part C or D'';
(3) in paragraph (7)--
(A) by inserting ``or the prevention of part or all
of a payment under this title based on a prepayment
review of a claim for payment'' after ``individual or
entity''; and
(B) by inserting ``or prepayment review'' after
``such overpayment'';
(4) in paragraph (8), by inserting ``(and, to the extent
that contracts under this subsection require prepayment review
of claims for payment under this title, on the performance of
such contractors with respect to such prepayment reviews)''
after ``recouping overpayments''; and
(5) by adding at the end the following new paragraph:
``(11) Funding for prepayment review.--For purposes of
making payment to recovery audit contractors for prepayment
review of claims for payment under this title, as described in
paragraph (1)(D), the Secretary shall provide for the transfer,
from the Federal Hospital Insurance Trust Fund under section
1817 and the Federal Supplementary Medical Insurance Trust Fund
under section 1841, in such proportion as the Secretary
determines appropriate based upon the relative amount of
improper payments that such contractors prevented from being
paid under parts A and B, of such sums as the Secretary
determines necessary, to the Centers for Medicare & Medicaid
Services Program Management Account.''.
(b) Regulations.--Not later than 1 year after the date of the
enactment of this section, the Secretary of Health and Human Services
shall issue such rules as are necessary to implement the amendments
made by subsection (a). Such rules shall include--
(1) a description of the methodology that the Secretary
shall use as the basis for making payment to recovery audit
contractors for the prepayment review of claims for payment
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.); and
(2) a description of the methodology that the Secretary
shall use to calculate savings to the Medicare program under
such title XVIII generated by such prepayment reviews.
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