No Medicare Clawbacks Act of 2026

Ritchie Torres

Democrat · NY · Representative

Source: Congress.gov · FEC

• Yvette D. Clarke (D-NY-9)Original· 2026-06-29

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.

2026-06-29

Source: Congress.gov

The proposal would prevent health insurance companies from taking back payments they made to doctors and hospitals in certain situations, protecting healthcare providers from unexpected financial penalties. This affects Medicare (the federal health insurance program for seniors and some disabled people) and the group health plans that many workers get through their employers. The bill aims to stop insurers from clawing back money after they've already paid medical claims, which can create financial hardship for healthcare providers.

AI-assisted summary generated from the official bill metadata (title, subjects, actions) sourced from Congress.gov. Cached and reviewed. Always verify against the official text linked below.

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 9532 Introduced in House (IH)] <DOC> 119th CONGRESS 2d Session H. R. 9532 To amend title XVIII of the Social Security Act to prohibit group health plan payment clawbacks in certain circumstances. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES June 29, 2026 Mr. Torres of New York (for himself and Ms. Clarke of New York) 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 prohibit group health plan payment clawbacks in certain circumstances. 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 ``No Medicare Clawbacks Act of 2026''. SEC. 2. PROHIBITING GROUP HEALTH PLAN PAYMENT CLAWBACKS IN CERTAIN CIRCUMSTANCES. Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended-- (1) in paragraph (1)(A)(ii)-- (A) by striking ``Clause (i)'' and inserting the following: ``(I) In general.--Clause (i)''; and (B) by adding at the end the following new subclause: ``(II) Prohibition on payment clawbacks in certain circumstances.--In the case of an item or service furnished to an individual entitled to benefits under this title under section 226(a) who is also enrolled in a group health plan, if clause (i) would otherwise apply to such individual and plan but for application of subclause (I) and if such plan initially makes payment for such item or service without regard to such entitlement, such plan may not later recoup such payment, in whole or part, on the basis that such individual was so entitled to such benefits, provided that-- ``(aa) such item or service was furnished during a period of retroactive coverage of part A benefits applicable to such individual; and ``(bb) at the time such item or service was furnished, such individual was not behind on any employee contribution owed by such individual with respect to enrollment in such plan.''; and (2) in paragraph (3)(A), by inserting ``or in the case of a group health plan that recoups payment in violation of paragraph (1)(A)(ii)(II)'' before the period. <all>

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