Preventing Hospital Overbilling of Medicare Act

This bill aims to stop hospitals from charging higher “hospital” prices for care done at clinics that are not on the main hospital campus. It pushes “same pay for the same care,” no matter where the service is done, and makes billing clearer so Medicare and other insurers can see exactly where care happened. It also lets federal health officials crack down on hospitals that bill off‑campus care as if it were done at the hospital itself .

Starting in 2026, each off‑campus hospital clinic, including off‑campus emergency departments, must use its own unique ID on claims and bill on standard professional claim forms, not as the main hospital. Insurers can reject incorrect claims, and patients can’t be billed unless the claim is filed the right way. The bill also removes special exceptions that let some off‑campus sites get higher hospital rates .

• Who is affected: People with Medicare and private insurance; hospitals with off‑campus clinics and emergency departments .
• What changes:
  • Off‑campus sites must have their own unique identifier and use it on claims; they must bill on HIPAA X12 837P or CMS‑1500 forms. Patients can’t be held liable if billing isn’t done this way.
  • Federal health officials can enforce “same pay for same care” and stop hospitals from billing off‑campus care as hospital care.
  • States are encouraged to adopt model rules so insurers can reject improper claims, based on an existing Colorado approach.
• When: Most changes apply to care on or after January 1, 2026 .