Sponsors (49)
Official title: To amend title XVIII of the Social Security Act to ensure appropriate payments under Medicare Advantage, and for other purposes.
Introduced June 30, 2026 by Lloyd Alton Doggett · Last progress June 30, 2026
The bill strengthens Medicare program integrity, transparency, and VA recovery while returning funds to the system, but it also ramps up audits, recovery powers, and reporting requirements that raise financial risk and administrative burdens for plans, providers, and potentially beneficiaries—creating a tradeoff between fiscal savings/oversight and access/costs for some enrollees.
Medicare beneficiaries and taxpayers: Medicare Advantage and Part D payments/risk-adjustment will more closely reflect true patient risk, reducing overpayments and helping preserve Medicare funds.
Medicare beneficiaries and the public: Stronger oversight, faster RADV audits, required MedPAC review, and new public subgroup analyses increase transparency and accountability of MA payment methods and selection patterns.
Veterans and the VA: VA will recover payments from MA/Part D plans, get faster claims payments with interest for late reimbursements, and face fewer insurer hurdles to reimbursing VA-provided care.
Medicare beneficiaries (especially low-income and those in concentrated MA markets): Lowered MA benchmarks, stricter audits, and stronger recovery tools could prompt plans to raise premiums, cut benefits or networks, or exit markets, reducing access and increasing out‑of‑pocket costs.
Medicare Advantage organizations, providers, and hospitals: Expanded audit powers (extrapolation), full-overpayment+interest penalties, contingency fees for recovery contractors, and treble damages exposure create large financial risk and could destabilize plan/provider finances.
Hospitals and specialty centers (teaching and transplant centers): Phasing out indirect medical education (IME) and excluding certain transplant acquisition payments from benchmarks may reduce hospital revenues and threaten availability of specialized services.
Based on analysis of 8 sections of legislative text.
Reforms MA/Part D risk-adjustment and audits, bans coding-tied payment incentives, and requires MA/PDP reimbursement to the VA, largely effective for 2028 plan years and later.
Changes how Medicare Advantage (MA) and Part D plans are paid and audited by excluding certain diagnosis sources from risk-adjustment, tightening audit and appeals deadlines, and creating a small user-fee to fund audits. It removes a county-quartile benchmark method, requires adjustments for favorable selection, bans provider payment incentives tied to coding, and forces MA/PDP plans to reimburse the VA for covered care provided to plan enrollees. Several provisions take effect for plan years or payments beginning in 2028 and later, and studies and reports to Congress are required within 2–3 years.