Bill > HR6863

This bill, known as the Centers for Medicare & Medicaid Services Auditor Transparency Act of 2025 or the CAT Act of 2025, aims to increase transparency and fairness when the Centers for Medicare & Medicaid Services (CMS) suspends payments to healthcare providers due to allegations of fraud. Currently, CMS and its contractors, like Unified Program Integrity Contractors (UPICs), have broad authority to suspend payments for up to a year while investigating credible allegations of fraud, which can significantly impact providers even if they are acting in good faith. The bill proposes several key changes: it requires CMS to provide providers with detailed information about the specific allegations of fraud, including the nature, date, and basis of the claim, at least 30 days before suspending payments, unless doing so would compromise the investigation. During a suspension, CMS must also provide regular updates on the investigation's findings and timeline, and offer providers an opportunity to ask questions. If CMS fails to meet these transparency requirements, payments must be immediately resumed, and any withheld funds with interest must be paid back. Furthermore, the bill mandates an independent appeals process for providers to challenge payment suspensions and requires CMS to submit an annual report to Congress detailing the number of suspensions, their basis, and their duration. These changes are intended to protect the financial stability of legitimate providers and ensure better due process while still allowing for effective fraud investigations within Medicare and Medicaid programs.

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https://www.congress.gov/bill/119th-congress/house-bill/6863/all-info