Sponsors (53)
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 and transparency—reducing overpayments, improving oversight, and protecting VA-provided care—but does so at the cost of greater enforcement power, heavier administrative and compliance burdens, and the risk that reduced MA payments or aggressive recoveries could limit benefits, raise costs, or disrupt access for some beneficiaries.
Medicare beneficiaries and taxpayers: Medicare Advantage (MA) payments and Part D risk-adjusted payments will more closely reflect true patient risk and reduce incentive-driven upcoding, which should lower improper payments and help preserve Medicare trust funds.
Medicare beneficiaries and the program: Stronger oversight (MedPAC review requirements, mandated HHS procedures, required subgroup analyses, and faster RADV audit/appeal timelines) will increase transparency and program integrity, making it easier to detect and correct payment errors.
Veterans and the VA: The VA will be able to recover payments from MA and Part D plans and will receive faster, interest-bearing reimbursements while being protected from insurers imposing extra documentation or utilization rules to deny VA-paid care.
Medicare Advantage enrollees (especially low-income or high-need beneficiaries): Lower MA payments or benchmark adjustments could prompt plans to narrow benefits or networks, raise premiums, or exit markets, reducing access and increasing out-of-pocket costs.
Medicare beneficiaries with complex needs: If legitimate diagnoses are excluded, adjusted incorrectly, or devalued under new verification/data rules, high-need patients could be underfunded, risking care coordination and access.
MA organizations, providers, and plans: Aggressive RADV tools (extrapolation of samples, contingency-fee recovery contractors, requirement to repay full overpayment plus interest, and limits on judicial review) greatly increase financial exposure and reduce legal recourse, potentially destabilizing plans or provider payments.
Based on analysis of 8 sections of legislative text.
Strengthens audit and verification of diagnoses used for MA/Part D payments, prohibits certain coding-based incentives, requires MA/PDP reimbursement to the VA, and modifies MA benchmark and RADV rules effective for 2028+.
Requires HHS to remove or adjust certain diagnosis codes and data sources from risk-adjusted payment formulas for Medicare Advantage and Part D starting with 2028, tightens audit and appeals timelines, creates new RADV user-fee funding, and bars provider payment incentives tied to coding. It also requires Medicare plans to reimburse the VA for VA-provided care covered by the plan and expands state coordination in enforcing MA requirements. MedPAC is directed to study survey-based alternatives for risk adjustment and the bill changes how MA benchmarks are calculated to account for favorable selection and certain cost exclusions.