What does Preamble of Medicare Payment Integrity Enhancement Act of 2026 do?

This bill amends title XVIII of the Social Security Act. It authorizes the Secretary of Health and Human Services to enter into contracts with recovery audit contractors. The contracts would allow for prepayment reviews under the Medicare program.

What does SHORT TITLE. of Medicare Payment Integrity Enhancement Act of 2026 do?

This bill is formally titled the Medicare Payment Integrity Enhancement Act of 2026

What does AUTHORIZING RECOVERY AUDITOR CONTRACTORS TO CONDUCT PREPAYMENT of Medicare Payment Integrity Enhancement Act of 2026 do?

This section amends Section 1893(h) of the Social Security Act to authorize recovery audit contractors to conduct prepayment reviews of claims for payment under Medicare. The amendments modify existing paragraphs to include provisions related to prepayment review and specify payment methodologies for these reviews. Payment to recovery audit contractors for prepayment review will be based on a methodology established by the Secretary, considering the amount of improper payments prevented and incentivizing timely and accurate prevention. The Secretary is required to transfer funds from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account to support prepayment review activities. The Secretary of Health and Human Services must issue regulations within one year of enactment to implement these changes, including a description of the payment methodology and a method to calculate savings generated by prepayment reviews.

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Medicare Payment Integrity Enhancement Act of 2026

Last updated: 5/13/2026 · Introduced: 5/13/2026

Author: Lloyd Smucker (R-PA)

TL;DR (AI)

This bill allows recovery audit contractors to perform prepayment reviews of Medicare claims to identify and prevent improper payments.
The bill establishes a payment methodology for recovery audit contractors based on the amount of improper payments prevented and incentivizes timely and accurate prevention.
To support prepayment review activities, the bill requires transfers of funds from Medicare trust funds to the Centers for Medicare & Medicaid Services Program Management Account.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 1 more.

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