Medicare Payment Integrity Enhancement Act of 2026

[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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