Medicare fraud oversight gets due-process guardrails—but at what cost?
H.R. 6863 — CAT Act of 2025 · Filed by Josh Harder (D-CA) · 1 cosponsor · Introduced Dec 18, 2025 · Referred to committee
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What it does
This bill requires Medicare and Medicaid to give healthcare providers 30 days' notice before suspending their payments during fraud investigations, explain the specific allegations in writing, provide updates every 30 days, and cap investigations at 180 days unless there is documented good cause to extend. It also requires an independent appeals process and annual reporting to Congress. The bill aims to protect legitimate providers from losing income during lengthy investigations while maintaining fraud oversight.
Why we flagged it
The bill's core mechanism is procedural: it adds transparency, notice, and appeals rights to Medicare/Medicaid payment-suspension investigations. It is not a tax cut, subsidy, or deregulation in the traditional sense, but rather a rebalancing of investigative power toward due process.
What the text implies
- The 180-day cap with 'good cause' exception may be difficult to enforce if 'good cause' is defined loosely by CMS, potentially recreating the indefinite suspension problem the bill aims to fix.
- Requiring detailed disclosure of fraud allegations 30 days before suspension could tip off providers under investigation, potentially allowing destruction of evidence or asset concealment in complex fraud schemes.
The full analysis lists 5 implications of this text.
Who stands to gain
healthcare providers (hospitals, clinics, suppliers); medical billing companies; healthcare legal services