H.R. 8871: DME Scammer Prevention Act of 2026

This bill, known as the DME Scammer Prevention Act of 2026, proposes changes to the way Medicare processes claims for certain medical equipment and supplies. Here’s a summary of its main components:

1. Electronic Submission of Claims

The bill requires that all providers and suppliers of specified medical equipment and supplies must submit their claims electronically. This amendment is aimed at improving the integrity of the Medicare program. Specified items will be defined in the law and will include those on a Master List established by Medicare.

2. Submission of Claims within 90 Days

The bill stipulates that providers must submit their claims for payment within 90 days from the date of service, specifically for applicable items, which are defined as specified items excluding certain exceptions. This change is designed to enforce a shorter time frame for claim submission, potentially leading to more timely payments and better tracking of claims.

3. Reporting Requirements

The Comptroller General of the United States is required to submit a report to Congress by January 1, 2030. This report will evaluate the technology used by Medicare administrative contractors to screen claims for specified items, focusing on identifying errors, waste, fraud, and abuse. The report will examine claims submitted in 2027, detailing:

• The total number of claims denied due to screening methods.
• The total number of those denied claims that were eventually paid.
• How effective the screening technology is in detecting suspicious claims and billing practices.

4. Definitions

The bill includes definitions for key terms such as "Medicare administrative contractor" and "specified items," establishing a legal framework for interpreting the bill's provisions.

Relevant Companies

• MDLZ (Mondelez International, Inc.): As a company that may deal with health-related products, changes in Medicare billing practices could impact their operations, particularly if they supply to facilities that bill Medicare.
• ABT (Abbott Laboratories): Abbott, involved in medical supplies and devices, could be directly affected by the new claims submission processes and requirements for specified items under Medicare.