I 

118TH CONGRESS 

2D SESSION H. R. 10006 

To amend title XVIII of the Social Security Act to improve transparency 

with respect to the suspension of Medicare payments pending an investigation into a credible allegation of fraud. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 18, 2024 

Mr. HARDER of California introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, 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 

A BILL 

To amend title XVIII of the Social Security Act to improve 

transparency with respect to the suspension of Medicare 

payments pending an investigation into a credible allegation of fraud. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Centers for Medicare 

5 & Medicaid Services Auditor Transparency Act of 2024’’ 

6 or the ‘‘CAT Act of 2024’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) In 2020, 139,000,000 individuals received 

4 health care coverage through the Medicare or Med5 icaid programs, costing the Federal Government ap6 proximately $1,500,000,000,000. Of these funds 

7 paid by United States taxpayers, $3,100,000,000 

8 were discovered to have been fraudulent claims. 

9 (2) Ensuring the integrity of the Medicare and 

10 Medicaid programs is crucial to preventing fraud, 

11 waste, and abuse and safeguarding the financial sus12 tainability of these important programs. 

13 (3) Even though the Centers for Medicare & 

14 Medicaid Services (CMS) utilization of Unified Pro15 gram Integrity Contractors (UPICs) has shown to 

16 be effective at identifying bad actors defrauding the 

17 Federal Government through the Medicare and Med18 icaid programs, current Federal law and regulations 

19 have shown to be harmful to most providers who are 

20 submitting Medicare and Medicaid claims in good 

21 faith. 

22 (4) Existing law provides CMS and UPICs 

23 broad authority and discretion to suspend Medicare 

24 payments for up to a year pending the investigation 

25 of ‘‘credible allegations of fraud’’. 


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1 (5) However, current law does not require ade2 quate transparency from CMS or UPICs into the 

3 nature of the alleged fraud before Medicare pay4 ments are suspended. Current law also does not re5 quire CMS or UPICs to provide adequate due proc6 ess to providers whose payments have been sus7 pended to challenge or cure the allegations of fraud 

8 prior to the suspension of Medicare payments. 

9 (6) In addition, anecdotal reports have shown 

10 that some UPICs extend the suspension of Medicare 

11 payments on a routine basis so that they may have 

12 additional time to finish their audit despite not pro13 viding evidence that the continuation of a payment 

14 suspension is necessary to protect the integrity of 

15 the Medicare program. 

16 (7) The broad authority to suspend Medicare 

17 payments pending the investigation of a credible al18 legation of fraud without adequate due process or 

19 transparency places the financial viability of many 

20 Medicare providers acting in good faith at risk. 

21 (8) If Medicare providers acting in good faith 

22 close their doors as a result of the unnecessary sus23 pension of payments by CMS or UPICs, Medicare 

24 beneficiaries and the American public could face ad25 ditional barriers to access to necessary health care 


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1 services as a direct result of unfair Federal law and 

2 regulations. 

3 SEC. 3. IMPROVING TRANSPARENCY IN SUSPENSION OF 

4 PAYMENTS PENDING INVESTIGATION OF 

5 CREDIBLE ALLEGATIONS OF FRAUD UNDER 

6 MEDICARE. 

7 (a) IN GENERAL.—Section 1862(o) of the Social Se8 curity Act (42 U.S.C. 1395y(o)) is amended— 

9 (1) in paragraph (1)— 

10 (A) by striking ‘‘The Secretary may sus11 pend’’ and inserting ‘‘Subject to paragraph (5), 

12 the Secretary may suspend’’; and 

13 (B) by inserting ‘‘An investigation of a 

14 credible allegation of fraud, and the suspension 

15 of payment pending such investigation under 

16 the preceding sentence, may only exceed 180 

17 days if the Secretary determines there is good 

18 cause to extend such investigation and suspen19 sion.’’ at the end; 

20 (2) in paragraph (4)— 

21 (A) by striking ‘‘a fraud hotline tip (as de22 fined by the Secretary)’’ and inserting ‘‘the fol23 lowing items’’; and 


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1 (B) by striking ‘‘credible allegation of 

2 fraud.’’ and inserting ‘‘credible allegation of 

3 fraud: 

4 ‘‘(A) A fraud hotline tip (as defined by the 

5 Secretary). 

6 ‘‘(B) Mere error (as defined by the Sec7 retary). 

8 ‘‘(C) A billing error found during the 

9 course of an audit that is attributable to human 

10 error.’’. 

11 (3) by adding at the end the following new 

12 paragraphs: 

13 ‘‘(5) TRANSPARENCY IN SUSPENSION OF PAY14 MENTS.— 

15 ‘‘(A) IN GENERAL.—The Secretary may 

16 only suspend payments to a provider of services 

17 or supplier under this title pursuant to para18 graph (1) if— 

19 ‘‘(i) subject to subparagraph (B), not 

20 later than 30 days before the date on 

21 which the payment suspension begins, the 

22 Secretary provides such provider of serv23 ices or supplier with information about 

24 each credible allegation of fraud that is the 


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1 basis for the payment suspension, includ2 ing— 

3 ‘‘(I) the specific nature of each 

4 credible allegation of fraud; 

5 ‘‘(II) the date of the alleged 

6 fraud; and 

7 ‘‘(III) the basis of the credible al8 legation of fraud, such as whether the 

9 allegation is based upon— 

10 ‘‘(aa) a fraud hotline com11 plaint; 

12 ‘‘(bb) data mining of data 

13 with respect to claims for pay14 ment under this title, title XIX, 

15 or title XXI; or 

16 ‘‘(cc) a pattern identified 

17 through audits of providers of 

18 services or suppliers; and 

19 ‘‘(ii) not less frequently than once 

20 every 30 days during such payment sus21 pension, the Secretary provides such pro22 vider of services or supplier with— 

23 ‘‘(I) a detailed, up-to-date list of 

24 the findings of the investigation; 


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1 ‘‘(II) an anticipated timeline for 

2 the completion of the investigation; 

3 and 

4 ‘‘(III) an opportunity to ask the 

5 Centers for Medicare & Medicaid 

6 Services questions regarding the pay7 ment suspension and the investiga8 tion. 

9 ‘‘(B) EXCEPTION.—The Secretary may 

10 elect not to provide a provider of services or 

11 supplier with the information described in 

12 clause (i) if the provision of such information 

13 does not compromise the integrity of the inves14 tigation, as determined by the Secretary in con15 sultation with the Inspector General of the De16 partment of Health and Human Services and 

17 State auditors (as appropriate). 

18 ‘‘(C) FAILURE TO PROVIDE INFORMA19 TION.—If the requirements described in sub20 paragraph (A) are not met with respect to the 

21 suspension of payment to a provider of services 

22 or a supplier under this title, the Secretary 

23 shall immediately resume such payment, and 

24 shall pay to the provider of services or supplier 

25 the amounts not paid due to such suspension 


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1 and any interest accrued with respect to such 

2 amounts. 

3 ‘‘(D) ANNUAL REPORT.—Not later than 

4 180 days after the end of each fiscal year (be5 ginning with fiscal year 2024), the Secretary 

6 shall submit to Congress a report that includes 

7 the following information with respect to such 

8 fiscal year: 

9 ‘‘(i) The number of payment suspen10 sions issued as the result of a pending in11 vestigation of a credible allegation of fraud 

12 under this subsection, section 1860D– 

13 12(b)(7) (including as applied pursuant to 

14 section 1857(f)(3)(D)), or section 

15 1903(i)(2)(C). 

16 ‘‘(ii) The basis of each such credible 

17 allegation of fraud. 

18 ‘‘(iii) The average duration of a pay19 ment suspension described in clause (i). 

20 ‘‘(iv) The average duration of an in21 vestigation of a credible allegation of fraud 

22 described in clause (i). 

23 ‘‘(v) If applicable, the average time 

24 between the completion of an investigation 

25 into a credible allegation of fraud described 


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1 in clause (i) and the reinstatement of pay2 ments to the relevant provider of services 

3 or supplier. 

4 ‘‘(6) APPEALS.—Not later than 180 days after 

5 the date of the enactment of the CAT Act of 2024, 

6 the Secretary shall provide an independent process 

7 by which a provider of services or supplier under 

8 this title that has received notice of a payment sus9 pension due to a pending investigation of a credible 

10 allegation of fraud pursuant to this subsection may 

11 appeal such suspension and receive a resolution of 

12 such appeal in a timely manner.’’. 

13 (b) STAKEHOLDER CONSULTATION.—In developing 

14 the appeals process required under section 1862(o)(6) of 

15 the Social Security Act, as added by subsection (a), the 

16 Secretary of Health and Human Services shall consult 

17 with relevant stakeholders, including providers of services 

18 and suppliers under title XVIII of the Social Security Act 

19 (42 U.S.C. 1395 et seq.), title XIX of such Act (42 U.S.C. 

20 1396 et seq.), and title XXI of such Act (42 U.S.C. 

21 1397aa et seq.), as determined appropriate by the Sec22 retary. 

23 (c) APPLICABILITY.—The amendments made by this 

24 section shall apply with respect to any investigation of a 

25 credible allegation of fraud under section 1862(o) of the 


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1 Social Security Act (42 U.S.C. 1395y(o)), section 1860D– 

2 12(b)(7) of such Act (42 U.S.C. 1395w–112(b)(7)) (in3 cluding as applied pursuant to section 1857(f)(3)(D) of 

4 such Act (42 U.S.C. 1395w–27(f)(3)(D))), or section 

5 1903(i)(2)(C) of such Act (42 U.S.C. 1396b(i)(2)(C)) that 

6 is initiated after the date of enactment of this Act. 

Æ 


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