DME Scammer Prevention Act of 2026
- Bill Number
- H.R. 8871
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-21: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 25 - 19.
- Last Updated
- 2026-06-03T20:29:44Z
AI-Generated Summary
Summary of H.R. 8871: DME Scammer Prevention Act of 2026
Purpose
This legislation aims to strengthen Medicare program integrity by requiring electronic claim submissions and faster filing deadlines for certain durable medical equipment and supplies. It seeks to help identify and reduce errors, waste, fraud, or abuse in the Medicare program.
Key Provisions
- Electronic Claims Submission: Amends the Social Security Act to mandate that all providers and suppliers submit claims electronically for "specified items" (medical equipment and supplies listed on the Master List under section 1834(a)(23)), effective January 1, 2027. This removes a prior exception allowing paper claims in some cases.
- 90-Day Claim Filing Deadline: Requires claims for "applicable items" (specified items excluding those on required face-to-face encounter lists, prior authorization lists, or paid on a monthly rental basis) to be submitted within 90 days of the service date, rather than the standard longer period.
- Government Accountability Office (GAO) Report: Directs the Comptroller General to submit a report to Congress by January 1, 2030, analyzing Medicare administrative contractors' use of screening technology for these claims during 2027. The report must examine denial rates, ultimate payment outcomes, and how the technology helps detect improper payments or suspicious billing.
Significant Changes to Existing Law
- Modifies section 1862(h) of the Social Security Act to apply electronic submission rules specifically to listed medical equipment and supplies starting in 2027.
- Updates section 1842(b)(3) to introduce a shorter 90-day filing window for applicable items and adjusts related timelines for claim processing and appeals.
- Adds new definitions for "specified items" and "applicable items" tied to existing Medicare lists and regulations.
- Introduces a mandatory GAO review of claims screening tools, which was not previously required for this category of items.
Potential Impacts
- Government Agencies: Medicare administrative contractors may need to update systems to enforce electronic submissions and 90-day deadlines, potentially increasing initial claim denials but improving fraud detection.
- Citizens: Medicare beneficiaries could experience faster claim processing for qualifying items but may face delays or denials if providers do not meet the new electronic or timing requirements.
- International Relations: No direct effects identified in the legislation.
- Overall, the changes could lead to more efficient oversight of Medicare spending on medical equipment while requiring adjustments in billing practices.
Main Stakeholders Affected
- Medicare providers and suppliers of durable medical equipment and supplies.
- Medicare beneficiaries receiving these items.
- Medicare administrative contractors responsible for claims processing and screening.
- The Comptroller General and Congress, due to the required reporting.
Notable Legal, Constitutional, or Political Implications
- The bill operates within the framework of the Social Security Act and does not appear to raise new constitutional issues, as it focuses on administrative changes to Medicare billing rules.
- It builds on existing program integrity measures, such as prior authorization and face-to-face requirements, without altering core Medicare eligibility or coverage rules.
- Politically, the legislation emphasizes fraud prevention in a specific area of Medicare, which could support bipartisan efforts to control program costs.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-05-21: Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 25 - 19.
- 2026-05-21: Committee Consideration and Mark-up Session Held
- 2026-05-19: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
- 2026-05-19: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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.
- 2026-05-19: Introduced in House
- 2026-05-19: Introduced in House
Bill Versions
- DME Scammer Prevention Act of 2026 — issued 2026-05-19 — PDF (5 pages)