DME Scammer Prevention Act

Summary#

This bill changes parts of the Social Security Act that affect Medicare billing for certain medical equipment and supplies. It adds a definition for "specified items": durable medical equipment and supplies furnished on or after January 1, 2027 that are on a Master List in section 1834(a)(23). The bill amends rules about electronic claim submission and about how soon claims must be filed. It creates a 90-day claim submission period for certain items and updates related timing language. The bill also directs the Comptroller General (GAO) to report to Congress by January 1, 2030 on the technology Medicare administrative contractors use to screen claims for the defined items. The GAO report must cover the one-year period starting January 1, 2027 and include counts of claims denied by screening and later paid, and an examination of how screening helps identify suspicious billing or the basis for denials.

What it means for you#

• If you provide or bill Medicare for durable medical equipment and supplies, the bill changes which items are defined as covered by the new rules and updates claim timing and submission requirements for those items.
• The bill sets a 90-day submission period for certain items and clarifies exceptions for items that already require a face-to-face encounter, written order before delivery, prior authorization, or are paid by monthly rental.
• The GAO will review how contractors use automated screening tools and report findings to Congress.

Expenses#

No publicly available information on costs or budgetary effects is included in the bill text provided.

Proponents' View#

The bill's stated purpose is to "promote Medicare program integrity with respect to certain medical equipment and supplies." No additional public statements or detailed supporter arguments are included in the provided text.

Opponents' View#

No publicly available information on opponents' views or formal objections is included in the provided text.