This bill amends the Social Security Act to prohibit Medicare payments for graduate medical education (GME) costs associated with individuals who are not citizens or nationals of the United States. Its core purpose is to ensure that federal funding for GME, which supports the training of medical residents, is exclusively directed towards U.S. citizens and nationals. This restriction would apply to both direct and indirect GME costs incurred by hospitals and other medical education providers. Specifically, the legislation mandates that, effective one year after its enactment, only U.S. citizens or nationals can be counted as residents for the purpose of calculating Medicare GME payments. This includes payments for direct GME costs, such as resident salaries, and indirect GME costs, which compensate teaching hospitals for the added complexity of patient care. The bill aims to prioritize the training of U.S. citizens and nationals within the Medicare-funded GME system. To enforce these new requirements, the bill establishes a series of escalating sanctions for healthcare providers that fail to comply. Hospitals and nonhospital providers that knowingly count non-citizen residents for GME payment purposes will face significant penalties. For a first offense, a civil monetary penalty equal to 25 percent of the payment amount attributable to non-citizens will be imposed, escalating to $1,000,000 for a second offense. Repeated violations will lead to more severe consequences, including exclusion from receiving Medicare GME payments for extended periods. A third offense would result in a 5-year exclusion from these payments, while each subsequent violation would lead to a 10-year exclusion . These measures are designed to ensure strict adherence to the new eligibility criteria for federal graduate medical education funding.