DME Scammer Prevention Act of 2026
HB8871, the “DME Scammer Prevention Act of 2026,” would amend Medicare rules to tighten program integrity controls for certain durable medical equipment (DME) and supplies. The bill focuses on “specified items” on a Medicare master list and would require electronic submission of claims for those items, with an exception carved out for certain items already subject to face-to-face encounter, written-order, prior-authorization, or monthly rental rules. It also changes Medicare claims filing deadlines so that claims for these applicable items generally must be submitted within 90 days of the date of service, rather than under the broader standard deadline that applies to other claims.
In addition to the claims-processing changes, the bill directs the Comptroller General to study how Medicare administrative contractors use screening technology to detect errors, suspicious claims, and possible waste, fraud, or abuse. The report would examine how often claims are initially denied by that technology, how often those denials are later reversed, and whether the screening tools are effectively identifying improper billing patterns.
The bill’s impact would be to amend Title XVIII of the Social Security Act, specifically Medicare claims and payment provisions, by creating a more targeted compliance regime for certain medical equipment and supply claims. It would affect Medicare providers and suppliers that bill for covered DME items, as well as Medicare administrative contractors responsible for claims screening and payment review. The bill also creates a new statutory definition of “specified items” tied to the Medicare master list and related regulatory lists.
The general sentiment reflected in the available context appears supportive of stronger anti-fraud measures, as shown by the committee’s decision to order the bill reported by a 25-19 vote. The bill’s framing as a scammer-prevention measure suggests an emphasis on reducing improper payments and abusive billing practices. No floor debate or transcript is provided, so the record here does not show broader public or partisan arguments beyond the committee vote.
The main point of contention is likely the balance between fraud prevention and administrative burden. Supporters would view the electronic-claims and shortened filing-deadline requirements as tools to curb waste, fraud, and abuse in a vulnerable Medicare payment area. Opponents may be concerned that tighter deadlines and more aggressive screening could create delays, increase denials, or burden legitimate DME suppliers and beneficiaries who rely on timely access to equipment and supplies.
The bill would amend sections 1862(h) and 1842(b)(3) of the Social Security Act to impose special Medicare billing rules for certain durable medical equipment and supplies, including mandatory electronic claims submission and a 90-day filing deadline for covered items. It would also require a GAO report on Medicare administrative contractor screening technology and its effectiveness in detecting improper claims, thereby affecting Medicare contractors, DME suppliers, and the claims review process.
The available record suggests generally favorable sentiment toward the bill’s anti-fraud purpose, as reflected in its committee approval by a 25-19 vote. The measure appears to have been advanced as a program-integrity and scam-prevention bill, indicating support for stronger oversight of Medicare DME billing. At the same time, the split vote suggests some concern about the operational effects of the new requirements on legitimate providers.
The likely controversy centers on whether the bill’s anti-fraud tools are appropriately targeted or overly burdensome. Supporters are likely to emphasize reduced waste, fraud, and abuse in Medicare durable medical equipment claims, while critics may argue that mandatory electronic filing and a shorter 90-day submission window could disadvantage compliant suppliers, increase administrative complexity, or lead to more initial denials. The GAO study requirement also signals concern about false positives and the accuracy of screening technology.