Section 1 Short title
This Act may be cited as the “No Medicare Clawbacks Act of 2026”.
No Medicare Clawbacks Act of 2026
A BILL
To amend title XVIII of the Social Security Act to prohibit group health plan payment clawbacks in certain circumstances.
Sec. 2 Prohibiting group health plan payment clawbacks in certain circumstances
Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is amended—
in paragraph (1)(A)(ii)—
by striking “Clause (i)” and inserting the following:
“(I) In general—Clause (i)”
by adding at the end the following new subclause:
“(II) Prohibition on payment clawbacks in certain circumstances—In the case of an item or service furnished to an individual entitled to benefits under this title under section 226(a) who is also enrolled in a group health plan, if clause (i) would otherwise apply to such individual and plan but for application of subclause (I) and if such plan initially makes payment for such item or service without regard to such entitlement, such plan may not later recoup such payment, in whole or part, on the basis that such individual was so entitled to such benefits, provided that—
“(aa) such item or service was furnished during a period of retroactive coverage of part A benefits applicable to such individual; and
“(bb) at the time such item or service was furnished, such individual was not behind on any employee contribution owed by such individual with respect to enrollment in such plan.”
in paragraph (3)(A), by inserting “or in the case of a group health plan that recoups payment in violation of paragraph (1)(A)(ii)(II)” before the period.