Sponsors (2)
The bill increases procedural protections, notice, appeals, and transparency for providers and Congress—helping protect provider finances and beneficiary access—but that trade-off may slow or complicate fraud suspensions, raise agency costs, and increase the risk of continued improper payments if protections are misapplied.
Hospitals and other Medicare/Medicaid providers receive clearer notice, regular updates, entitlement to back pay with interest for flawed suspensions, and a faster independent appeals process, reducing unexpected cash-flow disruptions and financial harm to providers.
Medicare and Medicaid beneficiaries are less likely to lose access to care because stronger procedural protections reduce the risk of unnecessary provider closures or prolonged payment interruptions.
Congressional reporting requirements and attention to transparency and due-process gaps increase oversight of suspension practices and support program integrity efforts that protect taxpayer funds and program solvency.
Limiting CMS's presumptive suspension authority and expanding what qualifies as a credible allegation (e.g., hotline tips, billing errors) could slow or limit swift suspensions, increasing the risk of continued improper payments and financial exposure for taxpayers and beneficiaries.
New disclosure, notice, hearing, and reporting requirements (including annual reports to Congress) will increase CMS administrative workload and costs and may require more staffing or resources.
Requiring additional pre-suspension disclosures or limiting what can be withheld risks compromising or delaying sensitive fraud investigations and law-enforcement operations, allowing fraudulent billing to continue longer in some cases.
Based on analysis of 3 sections of legislative text.
Limits CMS payment suspensions for suspected fraud, adds notice, reporting, and independent appeals, and requires annual reports to Congress.
Introduced December 18, 2025 by Josh Harder · Last progress December 18, 2025
Creates new rules limiting how long Medicare payments can be suspended while fraud is investigated and adds notice, reporting, and appeal steps before and during a suspension. Suspensions would generally stop after 180 days unless the Secretary of HHS shows good cause to extend, providers must get written notice and regular updates, missed notices require payment with interest, an independent appeals process must be created, and annual reports to Congress are required beginning in FY2025.