I 
119TH CONGRESS 
1ST SESSION H. R. 6863 
To amend title XVIII of the Social Security Act to improve transparency 
with respect to the suspension of Medicare payments pending an inves-
tigation into a credible allegation of fraud. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 18, 2025 
Mr. HARDER of California (for himself and Mrs. KIM) 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 sub-
sequently 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 allega-
tion of fraud. 
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 ‘‘Centers for Medicare 
& Medicaid Services Auditor Transparency Act of 2025’’ 
or the ‘‘CAT Act of 2025’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) In 2020, 139,000,000 individuals received 
health care coverage through the Medicare or Med-
icaid programs, costing the Federal Government ap-
proximately $1,500,000,000,000. Of these funds 
paid by United States taxpayers, $3,100,000,000 
were discovered to have been fraudulent claims. 
(2) Ensuring the integrity of the Medicare and 
Medicaid programs is crucial to preventing fraud, 
waste, and abuse and safeguarding the financial sus-
tainability of these important programs. 
(3) Even though the Centers for Medicare & 
Medicaid Services (CMS) utilization of Unified Pro-
gram Integrity Contractors (UPICs) has shown to 
be effective at identifying bad actors defrauding the 
Federal Government through the Medicare and Med-
icaid programs, current Federal law and regulations 
have shown to be harmful to most providers who are 
submitting Medicare and Medicaid claims in good 
faith. 
(4) Existing law provides CMS and UPICs 
broad authority and discretion to suspend Medicare 
payments for up to a year pending the investigation 
of ‘‘credible allegations of fraud’’. 
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(5) However, current law does not require ade-
quate transparency from CMS or UPICs into the 
nature of the alleged fraud before Medicare pay-
ments are suspended. Current law also does not re-
quire CMS or UPICs to provide adequate due proc-
ess to providers whose payments have been sus-
pended to challenge or cure the allegations of fraud 
prior to the suspension of Medicare payments. 
(6) In addition, anecdotal reports have shown 
that some UPICs extend the suspension of Medicare 
payments on a routine basis so that they may have 
additional time to finish their audit despite not pro-
viding evidence that the continuation of a payment 
suspension is necessary to protect the integrity of 
the Medicare program. 
(7) The broad authority to suspend Medicare 
payments pending the investigation of a credible al-
legation of fraud without adequate due process or 
transparency places the financial viability of many 
Medicare providers acting in good faith at risk. 
(8) If Medicare providers acting in good faith 
close their doors as a result of the unnecessary sus-
pension of payments by CMS or UPICs, Medicare 
beneficiaries and the American public could face ad-
ditional barriers to access to necessary health care 
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services as a direct result of unfair Federal law and 
regulations. 
SEC. 3. IMPROVING TRANSPARENCY IN SUSPENSION OF 
PAYMENTS 
PENDING 
INVESTIGATION 
OF 
CREDIBLE ALLEGATIONS OF FRAUD UNDER 
MEDICARE. 
(a) IN GENERAL.—Section 1862(o) of the Social Se-
curity Act (42 U.S.C. 1395y(o)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘The Secretary may sus-
pend’’ and inserting ‘‘Subject to paragraph (5), 
the Secretary may suspend’’; and 
(B) by inserting ‘‘An investigation of a 
credible allegation of fraud, and the suspension 
of payment pending such investigation under 
the preceding sentence, may only exceed 180 
days if the Secretary determines there is good 
cause to extend such investigation and suspen-
sion.’’ at the end; 
(2) in paragraph (4)— 
(A) by striking ‘‘a fraud hotline tip (as de-
fined by the Secretary)’’ and inserting ‘‘the fol-
lowing items’’; and 
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(B) by striking ‘‘credible allegation of 
fraud.’’ and inserting ‘‘credible allegation of 
fraud: 
‘‘(A) A fraud hotline tip (as defined by the 
Secretary). 
‘‘(B) Mere error (as defined by the Sec-
retary). 
‘‘(C) A billing error found during the 
course of an audit that is attributable to human 
error.’’. 
(3) by adding at the end the following new 
paragraphs: 
‘‘(5) TRANSPARENCY IN SUSPENSION OF PAY-
MENTS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
only suspend payments to a provider of services 
or supplier under this title pursuant to para-
graph (1) if— 
‘‘(i) subject to subparagraph (B), not 
later than 30 days before the date on 
which the payment suspension begins, the 
Secretary provides such provider of serv-
ices or supplier with information about 
each credible allegation of fraud that is the 
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basis for the payment suspension, includ-
ing— 
‘‘(I) the specific nature of each 
credible allegation of fraud; 
‘‘(II) the date of the alleged 
fraud; and 
‘‘(III) the basis of the credible al-
legation of fraud, such as whether the 
allegation is based upon— 
‘‘(aa) a fraud hotline com-
plaint; 
‘‘(bb) data mining of data 
with respect to claims for pay-
ment under this title, title XIX, 
or title XXI; or 
‘‘(cc) a pattern identified 
through audits of providers of 
services or suppliers; and 
‘‘(ii) not less frequently than once 
every 30 days during such payment sus-
pension, the Secretary provides such pro-
vider of services or supplier with— 
‘‘(I) a detailed, up-to-date list of 
the findings of the investigation; 
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‘‘(II) an anticipated timeline for 
the completion of the investigation; 
and 
‘‘(III) an opportunity to ask the 
Centers for Medicare & Medicaid 
Services questions regarding the pay-
ment suspension and the investiga-
tion. 
‘‘(B) EXCEPTION.—The Secretary may 
elect not to provide a provider of services or 
supplier with the information described in sub-
paragraph (A)(i) if the provision of such infor-
mation would compromise the integrity of the 
investigation, as determined by the Secretary in 
consultation with the Inspector General of the 
Department of Health and Human Services and 
State auditors (as appropriate). 
‘‘(C) FAILURE
TO
PROVIDE
INFORMA-
TION.—If the requirements described in sub-
paragraph (A) are not met with respect to the 
suspension of payment to a provider of services 
or a supplier under this title, the Secretary 
shall immediately resume such payment, and 
shall pay to the provider of services or supplier 
the amounts not paid due to such suspension 
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and any interest accrued with respect to such 
amounts. 
‘‘(D) ANNUAL
REPORT.—Not later than 
180 days after the end of each fiscal year (be-
ginning with fiscal year 2025), the Secretary 
shall submit to Congress a report that includes 
the following information with respect to such 
fiscal year: 
‘‘(i) The number of payment suspen-
sions issued as the result of a pending in-
vestigation of a credible allegation of fraud 
under this subsection, section 1860D– 
12(b)(7) (including as applied pursuant to 
section 
1857(f)(3)(D)), 
or 
section 
1903(i)(2)(C). 
‘‘(ii) The basis of each such credible 
allegation of fraud. 
‘‘(iii) The average duration of a pay-
ment suspension described in clause (i). 
‘‘(iv) The average duration of an in-
vestigation of a credible allegation of fraud 
described in clause (i). 
‘‘(v) If applicable, the average time 
between the completion of an investigation 
into a credible allegation of fraud described 
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in clause (i) and the reinstatement of pay-
ments to the relevant provider of services 
or supplier. 
‘‘(6) APPEALS.—Not later than 180 days after 
the date of the enactment of the CAT Act of 2025, 
the Secretary shall provide an independent process 
by which a provider of services or supplier under 
this title that has received notice of a payment sus-
pension due to a pending investigation of a credible 
allegation of fraud pursuant to this subsection may 
appeal such suspension and receive a resolution of 
such appeal in a timely manner.’’. 
(b) STAKEHOLDER CONSULTATION.—In developing 
the appeals process required under section 1862(o)(6) of 
the Social Security Act, as added by subsection (a), the 
Secretary of Health and Human Services shall consult 
with relevant stakeholders, including providers of services 
and suppliers under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), title XIX of such Act (42 U.S.C. 
1396 et seq.), and title XXI of such Act (42 U.S.C. 
1397aa et seq.), as determined appropriate by the Sec-
retary. 
(c) APPLICABILITY.—The amendments made by this 
section shall apply with respect to any investigation of a 
credible allegation of fraud under section 1862(o) of the 
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Social Security Act (42 U.S.C. 1395y(o)), section 1860D– 
12(b)(7) of such Act (42 U.S.C. 1395w–112(b)(7)) (in-
cluding as applied pursuant to section 1857(f)(3)(D) of 
such Act (42 U.S.C. 1395w–27(f)(3)(D))), or section 
1903(i)(2)(C) of such Act (42 U.S.C. 1396b(i)(2)(C)) that 
is initiated after the date of enactment of this Act. 
Æ 
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