H.R. 8804

[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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