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Medicare Payment Integrity Enhancement Act of 2026

USA119th CongressHR-8804| House 
| Updated: 5/13/2026
Lloyd Smucker

Lloyd Smucker

Republican Representative

Pennsylvania

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
This bill expands the role of **Recovery Audit Contractors (RACs)** within the Medicare program. It authorizes the Secretary of Health and Human Services to engage these contractors to perform **prepayment reviews** of claims, aiming to prevent improper payments before they are disbursed, rather than solely recouping them post-payment. A key provision establishes a new payment structure for RACs conducting prepayment reviews. Their compensation will be determined by a methodology established by the Secretary, which must consider the **amount of improper payments prevented** and incentivize timely, accurate prevention without disproportionate focus on specific claim types. This approach seeks to enhance Medicare payment integrity by shifting audit efforts to a proactive stage. The legislation mandates that the Secretary issue implementing regulations within one year of enactment, detailing the payment methodology for RACs and how the **savings generated** by these reviews will be calculated. Funding for these prepayment review activities will be transferred from the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds.
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Timeline
May 13, 2026
Introduced in House
May 13, 2026
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.
  • May 13, 2026
    Introduced in House


  • May 13, 2026
    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.

Medicare Payment Integrity Enhancement Act of 2026

USA119th CongressHR-8804| House 
| Updated: 5/13/2026
This bill expands the role of **Recovery Audit Contractors (RACs)** within the Medicare program. It authorizes the Secretary of Health and Human Services to engage these contractors to perform **prepayment reviews** of claims, aiming to prevent improper payments before they are disbursed, rather than solely recouping them post-payment. A key provision establishes a new payment structure for RACs conducting prepayment reviews. Their compensation will be determined by a methodology established by the Secretary, which must consider the **amount of improper payments prevented** and incentivize timely, accurate prevention without disproportionate focus on specific claim types. This approach seeks to enhance Medicare payment integrity by shifting audit efforts to a proactive stage. The legislation mandates that the Secretary issue implementing regulations within one year of enactment, detailing the payment methodology for RACs and how the **savings generated** by these reviews will be calculated. Funding for these prepayment review activities will be transferred from the Federal Hospital Insurance and Supplementary Medical Insurance Trust Funds.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
May 13, 2026
Introduced in House
May 13, 2026
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.
  • May 13, 2026
    Introduced in House


  • May 13, 2026
    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.
Lloyd Smucker

Lloyd Smucker

Republican Representative

Pennsylvania

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted