US HB4077 | 2015-2016 | 114th Congress


Spectrum: Partisan Bill (Republican 7-0)
Status: Introduced on November 18 2015 - 25% progression
Action: 2015-11-20 - Referred to the Subcommittee on Health.
Pending: House Subcommittee on Health Committee
Text: Latest bill text (Introduced) [PDF]


Medicare Established Provider Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to develop a system for designating providers that represent a low risk of submitting fraudulent Medicare claims as "established providers" for purposes of applying for special treatment in the claim review process. To qualify as an established provider, a provider must demonstrate that, within a specified timeframe: (1) at least 90% of Medicare claims submitted by the provider were determined to be eligible for full or partial payment, and (2) the provider appealed at least 90% of all Medicare claims that were not initially determined to be eligible for payment. HHS may withhold payment for a Medicare claim made by an established provider only if a final determination has been made that the claim is ineligible for payment. If such a final determination is made, the provider shall repay such payment electronically and within a specified timeframe.

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Medicare Established Provider Act of 2015



2015-11-20HouseReferred to the Subcommittee on Health.
2015-11-18HouseReferred to the Subcommittee on Health.
2015-11-18HouseReferred to House Energy and Commerce
2015-11-18HouseReferred to House Ways and Means
2015-11-18HouseReferred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2015-11-18HouseIntroduced in House


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