Medicare Payment Integrity Enhancement Act of 2026
HB8804, titled the Medicare Payment Integrity Enhancement Act of 2026, would amend the Social Security Act to let the Secretary of Health and Human Services contract with recovery audit contractors to conduct prepayment reviews of Medicare claims. Under current law, recovery audit contractors are primarily associated with identifying and recouping improper payments after they have been made; this bill expands that role to include stopping improper payments before they are issued.
The bill also directs HHS to create a payment methodology for these contractors that rewards the prevention of improper payments and encourages timely, accurate review without overemphasizing any one category of claims. It requires the Secretary to issue implementing regulations within one year, including methods for paying contractors and for calculating Medicare savings generated by prepayment review. The bill further specifies that funding for these reviews would come from transfers from the Medicare Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund to CMS’s Program Management Account, in proportions tied to the amount of improper payments prevented under Parts A and B.
If enacted, the bill would amend section 1893(h) of the Social Security Act and expand the statutory authority of recovery audit contractors within Medicare. It would create a new federal framework for prepayment review of claims, alter contractor compensation rules, and require CMS to develop savings and payment methodologies. The measure would affect Medicare providers and suppliers whose claims could be subject to additional review before payment, as well as CMS and the trust funds that finance Medicare administration and benefits.
The available record shows no committee transcript or vote history, so there is no direct evidence of debate, support, or opposition in the materials provided. Based on the bill text, the measure appears aimed at program integrity and reducing improper Medicare payments, which suggests a policy rationale likely to appeal to fiscal conservatives and oversight-focused lawmakers. At the same time, because it expands prepayment review authority, it could raise concerns among providers about administrative burden and payment delays.
The main point of contention is likely to be the balance between preventing improper payments and avoiding excessive claim denials or delays for legitimate Medicare claims. Supporters would likely emphasize fraud prevention, savings, and stronger payment integrity, while critics may worry that contractor incentives could lead to over-reviewing claims or disproportionately targeting certain services. The bill itself tries to address that concern by requiring a methodology that incentivizes accuracy and avoids a disproportionate focus on particular claim types.