Patient Refunds for Bad Denials Act of 2026

This bill would allow the federal Secretary of Health and Human Services to fine health insurance companies if, in a plan year beginning in 2027 or later, audits find that 25 percent or more of claims under a plan were denied. Denials for fraud or lack of medical necessity that the Secretary finds were correct would not count, and fraud denials count as correct only if the insurer shows proof. The fine could be up to $10 million plus $2 million for each percentage point above 25 percent, and the money collected would be paid out to the insurer's enrollees. Insurers would also have to explain their medical necessity standards when denying a claim on that basis and report their yearly claim denial rate to the Secretary.

Full text and official record on Congress.gov

Sponsors

• Angie Craig Democrat sponsor
• 1 cosponsors