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H.R. 9544: Saving Medicare Enrollees from Deceptive Insurers and Creating Ample Resources for Everyone Act of 2026

The bill would change how Medicare Advantage plans are paid and reviewed, with the goal of reducing overpayments tied to diagnosis coding and strengthening oversight.

Payment and coding changes

The bill would prevent Medicare Advantage plans from using certain diagnosis codes when calculating payments, including codes considered questionable or unsupported, as well as diagnoses found only through chart reviews or health risk assessments if they are not backed by an actual face-to-face medical encounter. It would also end payment incentives that reward plans for increasing reported diagnoses in ways that raise federal payments.

Audits, enforcement, and repayment

The bill would tighten audits of Medicare Advantage payments and make it easier for the government to recover overpayments. It would also give states more authority to help enforce these rules, adding another layer of oversight on how plans report diagnoses and receive payments.

Quality bonus changes

The bill would limit how long Medicare Advantage plans can receive certain quality bonus payments, reducing the period during which those bonuses may apply.

Veterans Affairs reimbursement

The bill would require Medicare Advantage plans and Medicare prescription drug plans to reimburse the Department of Veterans Affairs for covered care provided to eligible veterans when the VA pays for that care.

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Actions

2 actions

Date	Action
Jun. 30, 2026	Introduced in House
Jun. 30, 2026	Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

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