DME Scammer Prevention Act of 2026
Summary
What This Bill Does
The DME Scammer Prevention Act changes Medicare program-integrity rules for durable medical equipment and supplies on the CMS Master List. Beginning January 1, 2027, claims for specified equipment and supplies generally must be submitted within 90 days after service. The bill excludes items already subject to face-to-face or written-order lists, prior authorization, and monthly rental rules. The claim deadline is aimed at faster detection of suspect billing and payment problems.
The bill also requires the Government Accountability Office to report by January 1, 2030, on Medicare Administrative Contractor technology for screening DME claims. The GAO report must examine paid and denied claims, suspicious claims, aberrant billing patterns, and improper payments for specified items.
Who Benefits and How
Medicare beneficiaries benefit if faster claim submission and contractor screening reduce fraudulent equipment claims tied to their identities. CMS program-integrity staff benefit from a tighter claims timeline for Master List DME items. Medicare Administrative Contractors benefit from a GAO review of screening tools and suspicious-billing indicators. Federal taxpayers benefit if improper DME payments are detected earlier. Legitimate DME suppliers benefit when fraud-control rules target late or suspicious claims rather than all equipment billing equally.
Who Bears the Burden and How
DME suppliers must submit covered claims within 90 days and track which items are excluded from the new window. Medicare Administrative Contractors must apply the timing rule and produce data for GAO review. CMS program staff must identify specified items, maintain exclusions, and oversee implementation. Fraudulent DME suppliers face a shorter window for billing schemes. GAO auditors must evaluate contractor screening technology and claim outcomes.
Key Provisions
- Requires specified Medicare DME and supply claims to be submitted within 90 days after service beginning January 1, 2027.
- Excludes prior authorization items, monthly rental items, and selected face-to-face or written-order items from the new deadline.
- Directs GAO to report on Medicare contractor screening technology for DME claims by January 1, 2030.
- Requires the GAO report to assess paid claims, denied claims, suspicious claims, aberrant billing, and improper payments.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Creates a 90-day Medicare claim-submission window for specified durable medical equipment and supplies beginning in 2027, with exclusions for prior authorization, monthly rental, and certain order-list items, and requires GAO to report on contractor screening technology and suspicious billing.
Key Policy Areas
Medicare, Program Integrity, Durable Medical Equipment, Fraud Prevention
Primary Purpose
Creates a 90-day Medicare claim-submission window for specified durable medical equipment and supplies beginning in 2027, with exclusions for prior authorization, monthly rental, and certain order-list items, and requires GAO to report on contractor screening technology and suspicious billing.
Policy Domains
House resolution provisions
Identified Gains
- Medicare beneficiaries
- CMS program integrity staff
- Medicare Administrative Contractors
- Federal taxpayers
- Legitimate DME suppliers
Identified Costs
- DME suppliers
- Medicare Administrative Contractors
- CMS program staff
- Fraudulent DME suppliers
- GAO auditors
Sponsors
Legislative Progress
ReportedOrdered to be Reported in the Nature of a Substitute …
Committee Consideration and Mark-up Session Held
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Bean of Florida introduced the following bill; which was …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
CMS program integrity staff, Medicare Administrative Contractors, Medicare beneficiaries
Positive-direction: Medicare beneficiaries
Negative-direction: CMS program integrity staff, Medicare Administrative Contractors
GAO auditors, Taxpayers
Positive-direction: Taxpayers
Negative-direction: GAO auditors
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "cms"
- → Centers for Medicare and Medicaid Services
- "gao"
- → Government Accountability Office
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology