DME Scammer Prevention Act of 2026

Section 1862(h) of the Social Security Act (42 U.S.C. 1395y(h)) is amended—

(1) in paragraph (1)(A)(ii), by striking the entity and inserting except in the case of claims for specified items (as defined in paragraph (3)), the entity; and

(2) by adding at the end the following new paragraph:

(3) For purposes of paragraph (1)(A)(ii), the term specified items means medical equipment and supplies (as defined in section 1834(j)(5)) furnished on or after January 1, 2027, that are included on the Master List described in section 1834(a)(23).

Section 1842(b)(3) of the Social Security Act (42 U.S.C. 1395u(b)(3)) is amended—

(1) in subparagraph (B), in the flush matter following clause (ii), by inserting (or, in the case of claims for applicable items, the period ending 90 days after such date of service) after date of service; and

(2) in the flush matter following subparagraph (L)—

(A) in the sixth sentence—

(i) by inserting or end of the 90-day period specified in such subparagraph (as applicable) after close of the following calendar year; and

(ii) by inserting or end of such period (as applicable) after close of such year;

(B) in the ninth sentence, by inserting or 90-day period (as applicable) after 1 calendar year period; and

(C) by adding at the end the following new sentence: For purposes of subparagraph (B), the term applicable items means specified items (as defined in section 1862(h)(3)), other than any such item that is included on the Required Face-to-Face Encounter and Written Order Prior to Delivery List described in section 410.38(c)(8) of title 42, Code of Federal Regulations (or a successor regulation) or on the Required Prior Authorization List described in section 414.234(c)(1) of title 42 of such Code (or a successor regulation) or for which payment is made on a monthly rental basis..

Not later than January 1, 2030, the Comptroller General of the United States shall submit to Congress a report on the technology used by medicare administrative contractors to screen claims for specified items to identify errors or indicators of potential waste, fraud, or abuse. Such report shall include, with respect to the 1-year period beginning on January 1, 2027—

(A) an examination of—

(i) the total number of such claims submitted during such period for which payment was initially denied on the basis of such screening technology; and

(ii) the total number of claims so denied for which payment was ultimately made; and

(B) an examination of the extent to which the use of such screening technology (taking into account the amendments made by subsections (a) and (b)) assists in the identification of—

(i) suspicious claims or aberrant billing practices that may be indicative of improper payments; and

(ii) the basis of claims denials.

In this subsection:

The term medicare administrative contractor has the meaning given such term in section 1874A(a)(3) of the Social Security Act (42 U.S.C. 1395kk–1(a)(3)).

The term specified items has the meaning given such term in section 1862(h)(3) of the Social Security Act, as added by subsection (a).