DME Scammer Prevention Act of 2026

The "DME Scammer Prevention Act of 2026" seeks to strengthen Medicare program integrity concerning specific medical equipment and supplies. It introduces a new requirement for claims involving "applicable items" to be submitted within 90 days of the date of service, a significant reduction from the standard one-year period. These applicable items generally include medical equipment and supplies found on the Master List, with some exceptions for items requiring prior authorization or face-to-face encounters, or those paid on a monthly rental basis. The legislation also modifies the existing requirement for electronic submission of claims under Medicare. It creates a distinct category for "specified items," defined as medical equipment and supplies on the Master List furnished after January 1, 2027, altering how the general electronic submission rule applies to them. Furthermore, the bill mandates that the Comptroller General of the United States submit a report by January 1, 2030. This report will examine the effectiveness of technology used by Medicare administrative contractors to screen claims for specified items, focusing on identifying errors, waste, fraud, and abuse, and analyzing denial rates and the utility of such screening tools.