HR-8871-119
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 25 - 19.
Sponsored by Aaron Bean (R-FL)
What it does
This bill would amend the Social Security Act to add two new requirements for Medicare claims involving certain durable medical equipment (DME) and supplies on the Medicare Master List. First, it would require all such claims to be submitted electronically, removing an existing exemption that allowed paper submissions. Second, it would shorten the window for submitting those claims from one calendar year to 90 days after the date of service, with exceptions for items requiring prior authorization, face-to-face encounters, or paid on a monthly rental basis. The bill also directs the Comptroller General to report to Congress by January 1, 2030, on how Medicare administrative contractors use screening technology to detect fraud, waste, and abuse in DME claims.
Who benefits
Medicare program as a whole, which may see reduced fraudulent or erroneous DME payments. Taxpayers who fund Medicare. Legitimate DME suppliers who compete against fraudulent billers. Patients whose Medicare benefits are protected from depletion by fraud. The Government Accountability Office (GAO), which gains a formal mandate to evaluate screening technology effectiveness. Congress, which gains oversight data on DME fraud detection.
Who is hurt
Small or rural DME suppliers with limited technology infrastructure who may struggle to meet the electronic submission requirement. Suppliers who currently rely on the full calendar-year window to resolve billing disputes or gather documentation before submitting claims. Patients in areas with limited DME supplier options, if smaller suppliers exit the market due to compliance costs. Medicare administrative contractors, which may face increased operational demands to implement and enforce the new rules. Suppliers of items excluded from the 90-day rule (prior authorization, face-to-face, monthly rental) face no change, but those not excluded face a significantly tighter timeline.
Supporters argue
Supporters argue that DME fraud is one of Medicare's most persistent and costly vulnerabilities — the HHS Office of Inspector General has repeatedly identified DME as a high-risk area, with billions in improper payments annually. They contend that electronic submission enables real-time automated screening that paper claims cannot, and that a 90-day filing window closes a loophole that fraudulent suppliers exploit by submitting claims long after any meaningful clinical verification is possible. Tighter timelines and electronic trails, they argue, make it far harder to fabricate or backdate equipment deliveries.
Opponents argue
Opponents argue that the 90-day window may be unworkably short for legitimate suppliers serving complex patients, where documentation from physicians, insurers, and patients can take months to compile — particularly for items not covered by the prior authorization or face-to-face exceptions. They contend that small and rural DME suppliers, who often serve the most medically underserved Medicare beneficiaries, may lack the resources to meet mandatory electronic submission requirements, potentially reducing patient access to equipment in areas that already have few providers.
Constitutional context
Congress has broad authority to set conditions on Medicare spending under the Taxing and Spending Clause (Art. I, §8, cl. 1), and NFIB v. Sebelius (2012) affirmed wide congressional latitude to structure federal health program rules. No significant constitutional tension is present here, as this bill modifies administrative procedures within an existing federal program rather than imposing mandates on states or private parties outside the program.
Checks and balances
Congress gains tighter control over Medicare DME billing procedures; HHS and Medicare administrative contractors implement and enforce the new rules; the GAO provides independent oversight through the mandated report to Congress.
Historical precedent
Congress has previously enacted DME-specific program integrity measures, including competitive bidding requirements and prior authorization programs under the Medicare Improvements for Patients and Providers Act (2008) and subsequent legislation, which similarly targeted high-fraud DME categories.