DME Scammer Prevention Act of 2026
- Sponsor
- Rep. Bean, Aaron [R-FL-4]
- Committees
- Ways and Means Committee (primary)
- Last action
- May 21, 2026
Bottom line
The bill tightens Medicare billing rules for certain medical equipment and supplies to combat fraud, waste, and abuse, while also mandating a review of the effectiveness of these new measures.
What it actually does
This bill amends the Social Security Act to enhance Medicare program integrity for durable medical equipment (DME) and supplies. It mandates electronic submission of claims for specific DME items and requires claims for certain 'applicable items' to be submitted within 90 days of service. It also commissions a report from the Comptroller General on the effectiveness of screening technology for these claims.
Proponents argue
Supporters argue that this bill will significantly reduce waste, fraud, and abuse within the Medicare program by closing loopholes that allow for delayed or non-electronic claims, which are harder to track and screen. They contend that these measures will protect taxpayer dollars and ensure that Medicare funds are used appropriately for legitimate medical needs, ultimately strengthening the program's financial health.
Opponents contend
Critics might argue that while the intent to prevent scams is laudable, the new electronic submission and 90-day claim window requirements could place an undue administrative burden on legitimate healthcare providers, particularly smaller practices or those in rural areas with limited technological infrastructure. They may also contend that legitimate claims could be denied due to technicalities, potentially delaying patient access to necessary medical equipment and supplies.
The bill is short and focused, making it accessible for an informed reader to evaluate its core provisions within a reasonable timeframe.
Section 2(a)
Mandatory Electronic Submission of Claims for Specified Items
This provision amends current law to require all providers and suppliers to submit claims electronically for certain medical equipment and supplies, referred to as 'specified items.' These items are defined as those on Medicare's Master List of medical equipment and supplies furnished on or after January 1, 2027. This removes a previous general exception for entities from electronic submission requirements for these particular items.
Supporters argue
Supporters argue that mandating electronic submission for these specific items will significantly enhance Medicare's ability to screen for fraudulent or erroneous claims, as electronic data is easier to process and analyze. This will streamline operations and reduce the opportunity for bad actors to exploit manual processes.
Critics contend
Opponents might contend that while electronic submission is generally good, a blanket mandate without exceptions for certain providers (e.g., those with limited internet access or small-scale operations) could create unnecessary administrative hurdles and potentially delay legitimate claims processing.
Tradeoffs
The provision balances the benefit of increased program integrity and efficiency through electronic data against the potential for increased administrative burden on providers who may not be fully equipped for mandatory electronic submission.
Section 2(b)
90-Day Claim Submission Window for Applicable Items
This section establishes a new requirement for claims related to 'applicable items' to be submitted within 90 days of the date of service. 'Applicable items' are a subset of 'specified items,' excluding those already subject to face-to-face encounter requirements, prior authorization, or monthly rental payments. This shortens the standard claim submission window for these specific medical equipment and supplies.
Section 2(c)
Comptroller General Report on Screening Technology
This section mandates that the Comptroller General of the United States submit a report to Congress by January 1, 2030. The report will evaluate the technology used by Medicare administrative contractors to screen claims for 'specified items' for errors, waste, fraud, or abuse. It will specifically examine the number of claims initially denied by this technology and ultimately paid, and assess the technology's effectiveness in identifying suspicious claims and the basis for denials.
The definition of 'applicable items' for the 90-day claim submission window explicitly excludes several categories of 'specified items': those on the Required Face-to-Face Encounter and Written Order Prior to Delivery List (42 CFR 410.38(c)(8)), those on the Required Prior Authorization List (42 CFR 414.234(c)(1)), or items paid on a monthly rental basis.
Section 2(b)(2)(C)
Why it matters:The use of cross-references to existing regulations is standard legislative practice for brevity and to integrate new rules into the existing legal framework. However, it can make the precise scope of the new rule less immediately obvious to a casual reader.
Case for: Proponents would argue that these exclusions are necessary to avoid creating redundant or conflicting requirements for items that already have robust integrity safeguards (like prior authorization or face-to-face encounters) or have different billing cycles (monthly rentals). This ensures the new 90-day rule targets specific areas of vulnerability without over-regulating.
Case against: Critics might argue that by excluding these categories, the bill leaves potential gaps in its program integrity efforts, as these excluded items could still be susceptible to fraud or abuse if their existing safeguards are not fully effective. The complexity of these exclusions could also lead to confusion among providers.
Estimated impact: This carve-out significantly narrows the universe of 'specified items' that will be subject to the new 90-day claim submission deadline, focusing the impact on a particular subset of DME claims.