Sponsor
The bill strengthens remedies for suppliers by allowing recovery of attorney fees and encouraging more accurate contractor decisions (with added transparency), but it raises fiscal and administrative costs and leaves some providers uncertain about eligibility and potential clawbacks.
Hospitals, health systems, and suppliers: contractors sharing financial responsibility for clearly erroneous denials creates an incentive for more accurate initial Medicare claims decisions, which could reduce improper denials over time.
Small durable medical equipment (DME) suppliers and other providers: can recover reasonable attorney fees and litigation costs (including at multiple appeal stages), reducing the financial burden of appealing incorrect Medicare denials and improving access to effective legal relief.
Taxpayers and policymakers: the Secretary must report aggregated data on fee awards, increasing transparency about denial reversals, fee usage, and appeals outcomes to support oversight and policy evaluation.
Taxpayers and Medicare contractors: fee awards could increase contractor liabilities and overall Medicare program spending if awards are large or frequent, creating fiscal pressure on the program and potentially higher costs for taxpayers.
Small suppliers and contractors (and hospitals): the new application, service, response, recordkeeping, and reporting requirements will raise administrative and compliance costs and add operational burden.
Suppliers who receive awards: possibility of later clawbacks or offsets if a subsequent determination reverses the favorable appeal or finds fraud, creating financial uncertainty for providers who relied on awards.
Based on analysis of 2 sections of legislative text.
Allows Medicare to pay reasonable attorney fees and costs to DME suppliers who prevail on appeals after incorrect payment denials and directs the Secretary to set rules for awards and safeguards.
Senator · R-LA
Authorizes Medicare to pay reasonable attorney fees, costs, and certain expenses to durable medical equipment (DME) suppliers that prevail on appeals when a Medicare contractor or the Department incorrectly denied payment or reimbursement. The bill directs the Secretary to create rules on who is eligible, how fees are calculated and disputed, safeguards against improper payment, and processes for reconsideration and recovery if later decisions reverse the award. Provides a pathway for small-business DME suppliers that obtain a favorable, final decision at the Office of Medicare Hearings and Appeals to recover fees and litigation costs when the initial Medicare determination is clearly erroneous, unsupported by substantial evidence, or inconsistent with law or policy; establishes procedures for applying for awards and dividing liability among contractors that affirmed or made the initial denial.
Official title: Amend title XVIII of the Social Security Act to require medicare administrative contractors, unified program integrity contractors, and qualified independent contractors to pay the legal fees for certain durable medical equipment suppliers that were incorrectly denied payment.
Introduced July 22, 2026 by Bill Cassidy · Last progress July 22, 2026