FAIR DME Appeals Act

This bill would require certain Medicare contractors to pay the attorney fees and litigation costs of small-business durable medical equipment suppliers that win an appeal before a Medicare administrative law judge. The judge must find the contractor's original payment denial was clearly erroneous, not supported by substantial evidence, or did not follow applicable rules. Suppliers would apply within 30 days, contractors could respond, and the judge would set a non-appealable fee amount. Fees would not be paid when the denial resulted from missing documentation, billing errors, later changes in guidance, or local coverage determinations, and suppliers who won through fraud would have to return the fees. The Secretary of Health and Human Services could not cover these costs for contractors, and rules would be due within 2 years.

Full text and official record on Congress.gov

Sponsors

• Bill Cassidy Republican sponsor
• 0 cosponsors