I 
119TH CONGRESS 
1ST SESSION H. R. 4077 
To amend title 38, United States Code, and the Social Security Act to 
permit recovery from the Department of Veterans Affairs of costs from 
Medicare Advantage and Medicare prescription drug plans and to modify 
the authority for recovery by the United States of reasonable charges 
for certain care or services furnished to veterans for non-service-con-
nected disabilities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 23, 2025 
Mr. DOGGETT (for himself, Mr. MURPHY, Mr. TAKANO, Mr. SCHWEIKERT, 
and Mr. JOYCE of Pennsylvania) introduced the following bill; which was 
referred to the Committee on Veterans’ Affairs, and in addition to the 
Committees on Ways and Means, and Energy and Commerce, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title 38, United States Code, and the Social Secu-
rity Act to permit recovery from the Department of 
Veterans Affairs of costs from Medicare Advantage and 
Medicare prescription drug plans and to modify the au-
thority for recovery by the United States of reasonable 
charges for certain care or services furnished to veterans 
for non-service-connected disabilities, and for other pur-
poses. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Guarantee Utilization 
of All Reimbursements for Delivery of Veterans’ Health 
Care Act’’ or the ‘‘GUARD Veterans’ Health Care Act’’. 
SEC. 2. COST-RECOVERY FROM MEDICARE ADVANTAGE 
AND MEDICARE PRESCRIPTION DRUG PLANS. 
(a) COST RECOVERY.— 
(1) IN GENERAL.—Subchapter III of chapter 
17 of title 38, United States Code, is amended by 
inserting after section 1729B the following new sec-
tion: 
‘‘§ 1729C. Cost-recovery from Medicare Advantage 
and Medicare prescription drug plans 
‘‘(a) 
IN
GENERAL.—Notwithstanding 
sections 
1814(c), 1835(d), and 1862(a)(3) of the Social Security 
Act (42 U.S.C. 1395f(c), 1395n(d), and 1395y(a)(3)), if 
the Secretary provides under this chapter any health care 
item or service (including for a service-connected disability 
or a non-service-connected disability) covered under the 
Medicare program under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.), including outpatient and 
inpatient care, prescription drugs, medical devices, lab 
testing, and items or services delivered in post-acute and 
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long-term care settings, to any individual who is enrolled 
in a Medicare Advantage plan, including an MA–PD plan, 
offered by a MA organization under part C of such title 
or a prescription drug plan offered by a PDP sponsor 
under part D of such title, such organization or sponsor 
shall, to the extent such item or service is covered under 
such Medicare Advantage plan or prescription drug plan, 
reimburse the Secretary for such item or service regardless 
of any additional documentation, utilization management, 
or other administrative requirement the plan may impose 
on the item or service. 
‘‘(b) RECOVERY OF AMOUNTS.— 
‘‘(1) IN GENERAL.—The Secretary shall recover 
amounts required to be reimbursed under subsection 
(a) through the use of procedures under section 
1729 of this title to the same extent as those proce-
dures are used to recover amounts authorized to be 
recovered under that section. 
‘‘(2) AMOUNT AND PROCESS.—Except as pro-
vided in paragraph (1), recovery under that para-
graph of amounts reimbursed under subsection (a) 
shall be in such an amount, and occur in accordance 
with such procedures, as the Secretary shall pre-
scribe for purposes of this section. 
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to any and all causes of action or recovery rights in tort 
or under any policy, plan, or contract providing benefits 
for health care or injury, which accrue to the individual 
to whom the care or services were furnished, or to the 
legal representatives of the individual, as a result of the 
non-service-connected disability that necessitated the care 
or services.’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (D), by striking 
‘‘; or’’ and inserting a semicolon; 
(ii) in subparagraph (E)(2), by strik-
ing the period at the end and inserting ‘‘; 
or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) that is incurred by an individual who is 
entitled to care (or payment of expenses of care) 
under circumstances creating a tort liability upon a 
third party.’’; 
(2) in subsection (b), by amending paragraph 
(2) to read as follows: 
‘‘(2)(A) The United States may take any action nec-
essary to enforce the subrogation interests of the United 
States under this section, including by intervening or join-
ing in an action or proceeding. 
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‘‘(B) A proceeding under this section may not be 
brought after the end of the six-year period beginning on 
the last day on which the care or services for which recov-
ery is sought are furnished. Notwithstanding the previous 
sentence, subject to section 2415 of title 28, and except 
as otherwise provided by law, any action for money dam-
ages under this section brought by the United States or 
an officer or agency thereof that is founded upon a tort 
shall be barred unless the complaint is filed within three 
years after the right of action first accrues.’’; 
(3) in subsection (c)(1), by inserting ‘‘or pen-
alty’’ after ‘‘claim’’; 
(4) by redesignating subsections (h) and (i) as 
subsections (l) and (m), respectively; 
(5) by inserting after subsection (f) the fol-
lowing new subsections: 
‘‘(g)(1) Not later than 45 days after receipt of a 
claim to recover or collect the reasonable charges for care 
or services described in subsection (a), or in the case of 
a tort, not later than 45 days after settlement, judgment, 
award, liability determination, or resolution relating to the 
cause of action, a third party shall— 
‘‘(A) pay a clean claim for reimbursement in ac-
cordance with this section; 
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‘‘(B) pay the amount agreed to in writing by 
the Department; or 
‘‘(C) provide notice of the date the third party 
received the claim and include a statement that— 
‘‘(i) the third party refuses to reimburse 
all or part of the claim and specify each reason 
for the refusal to pay; or 
‘‘(ii) additional information is necessary to 
determine if all or part of the claim will be re-
imbursed and what specific additional informa-
tion is necessary. 
‘‘(2) Paragraph (1) shall not apply to a claim if there 
is a good faith dispute about the legitimacy of the claim. 
‘‘(3)(A) If any third party fails to comply with para-
graph (1), such third party shall be required to pay inter-
est to the United States at the rate established by the 
Secretary of the Treasury under section 3717 of title 31 
per month on the amount of the claim that remains un-
paid at the end of the 45-day period specified in such 
paragraph. 
‘‘(B) The interest paid pursuant to subparagraph (A) 
shall be included in any late reimbursement from a third 
party without requiring the Secretary to make any addi-
tional claim for such interest. 
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‘‘(4)(A) Upon receiving a request for additional infor-
mation by a third party pursuant to paragraph (1)(C)(ii), 
the Secretary shall provide the additional information, if 
determined relevant by the Secretary, not later than 45 
days after receipt of the request for additional informa-
tion. 
‘‘(B) Failure to furnish relevant information within 
the time required under subparagraph (A) shall not invali-
date or reduce any claim in connection with such informa-
tion. 
‘‘(C)(i) Not later than 15 days after receipt of addi-
tional relevant information under subparagraph (A), a 
third party shall pay a clean claim in accordance with this 
subsection or send a written or electronic notice that— 
‘‘(I) such third party refuses to reimburse all or 
part of the claim; and 
‘‘(II) specifies each reason for refusal to pay. 
‘‘(ii) Any third party that fails to comply with clause 
(i) shall pay interest to the United States on any amount 
of the claim that remains unpaid at the rate established 
by the Secretary of the Treasury under section 3717 of 
title 31. 
‘‘(5) A third party shall not be entitled to request 
a refund to correct a payment error to the Department 
if the request by the third party for such payment correc-
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tion is submitted more than 18 months after the date that 
the Department received payment from the third party. 
‘‘(6) Any claim by the Department under this section 
shall not be subject to non-Department claims processes, 
policies, or forms. 
‘‘(h) The recovery rights of the United States under 
this section are not limited to the amounts paid to non- 
Department providers and are not subject to non-Depart-
ment fee schedules or non-Department reimbursement 
rates, including those administered under workers’ com-
pensation plans or automobile accident reparations insur-
ance. 
‘‘(i)(1) A third party shall— 
‘‘(A) determine whether a recipient of care or 
services covered by this section (including a recipient 
whose claim is unresolved) has received benefits 
under this chapter; and 
‘‘(B) submit the information described in para-
graph (2) with respect to the recipient to the Sec-
retary in a form and manner (including frequency) 
specified by the Secretary. 
‘‘(2) The information required to be submitted under 
this paragraph with respect to a recipient of care or serv-
ices is— 
‘‘(A) the identity of the recipient; and 
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‘‘(B) such other information as the Secretary 
shall specify in order to enable the Secretary to 
make an appropriate determination concerning co-
ordination of benefits, including any applicable re-
covery claim. 
‘‘(3) A third party shall submit the information re-
quired under paragraph (1)(B) with respect to a recipient 
of care or services covered by this section (including a re-
cipient whose claim is unresolved) not later than 30 days, 
or such other time period as prescribed by the Secretary, 
after the date on which the third party knows or has rea-
son to know that the recipient has received benefits under 
this chapter. 
‘‘(4) A third party shall not distribute proceeds of 
a settlement, judgment, award, or other payment in con-
nection with a recipient of care or services covered by this 
section (including a recipient whose claim is unresolved), 
regardless of whether there has been a determination or 
admission of liability, without satisfaction of a claim by 
the Department. 
‘‘(j)(1) A third party that fails to comply with the 
requirements under this section, including any regulations 
prescribed to implement this section, with respect to any 
individual receiving care furnished or paid for by the De-
partment as described in this section, shall be subject to 
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a civil penalty in an amount published on a website of 
the Department for each day of noncompliance with re-
spect to each claim violation. A civil penalty under this 
paragraph shall be in addition to any other penalties pre-
scribed by law. 
‘‘(2)(A) A third party that willfully fails or refuses 
to pay a clean claim under this section, including any reg-
ulations prescribed to implement this section, with respect 
to any individual receiving care furnished or paid for by 
the Department as described in this section, shall be sub-
ject to paying the higher of triple the amount of the claim 
or an amount not to exceed $50,000, which may be ad-
justed for inflation, for each claim violation. 
‘‘(B) A penalty under subparagraph (A) is in addition 
to any other penalty under this subsection and any other 
penalty prescribed by law. 
‘‘(C) Before enforcing any penalty under this para-
graph with respect to a third party, the Secretary shall 
provide to the third party written notice of the amount 
due and a 30-day opportunity to pay the clean claim, in-
cluding penalties, interests, and costs. 
‘‘(3) Notwithstanding any other applicable civil or 
criminal remedies, the United States shall have a cause 
of action for damages (which shall be in an amount double 
the amount otherwise provided) in the case of a third 
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party that fails to provide payment, or appropriate reim-
bursement, for the reasonable value of the care or services 
furnished, to be furnished, paid for, or to be paid for in 
accordance with a clean claim. 
‘‘(k) Notwithstanding any other provision of law, the 
Secretary may implement this paragraph by prescribing 
regulations, program instructions, or otherwise.’’; and 
(6) in subsection (m), as redesignated by para-
graph (4)— 
(A) in paragraph (3)— 
(i) in subparagraph (C), by striking ‘‘; 
or’’ and inserting a semicolon; 
(ii) in subparagraph (D), by striking 
the period at the end and inserting a semi-
colon; and 
(iii) by adding at the end the fol-
lowing new subparagraphs: 
‘‘(E) a person or entity responsible in tort 
for damages incurred as a result of negligence; 
or 
‘‘(F) a person or entity responsible for 
payment of medical expenses other than under 
a health-plan contract, including medical ex-
penses coverage, medical payments coverage, or 
underinsured motorist coverage.’’; and 
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(B) by adding at the end the following new 
paragraphs: 
‘‘(4) The term ‘clean claim’ means a claim to 
recover or collect reasonable charges under sub-
section (a) that can be processed without obtaining 
additional information. 
‘‘(5) The term ‘non-service-connected disability’ 
includes— 
‘‘(A) a non-service-connected disability, in-
jury, illness, health care need, or condition; and 
‘‘(B) an aggravation or exacerbation of a 
service-connected disability.’’. 
Æ 
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