Medicare outsources lab-test pricing to a single private data broker—with no transparency rules.
S. 2761 — RESULTS Act · Filed by Thom Tillis (R-NC) · 13 cosponsors · Introduced Sep 10, 2025 · Referred to committee
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What it does
This bill amends Medicare's payment system for clinical diagnostic laboratory tests by requiring the government to contract with an independent nonprofit organization to collect private insurance claims data and use that data to set more accurate Medicare payment rates for these tests. Starting in 2028, Medicare will use actual private payor rates from a comprehensive claims database (containing at least 50 billion claims from over 50 insurers) instead of relying solely on laboratory self-reporting, with fallback payment adjustments if no data is available.
Why we flagged it
The bill's core function is to improve the accuracy of Medicare laboratory test payment rates by mandating use of private claims data collected by an independent nonprofit. However, the operative mechanism—contracting with a single qualifying entity to control access to a proprietary database—creates a structural dependency that may benefit the intermediary organization and the insurers whose data it aggregates, not just Medicare beneficiaries.
What the text implies
- The bill designates a single 'qualifying independent claims data entity' as the exclusive source of private payor claims data for Medicare rate-setting, creating a potential monopoly over a critical input to federal payment policy without explicit governance safeguards, transparency requirements, or conflict-of-interest rules for the intermediary.
- The 'qualifying comprehensive claims database' must contain data from 'more than 50 private payors' but the bill does not require disclosure of which payors are included, their market share, or whether the database is representative of all geographic regions and demographic groups, risking skewed payment rates based on incomplete or biased data.
The full analysis lists 5 implications of this text.
Who stands to gain
Independent nonprofit claims data aggregator (designated intermediary); Private insurance companies and claims administrators (whose data becomes the basis for Medicare rat; Laboratory testing companies (if rates are set based on data that reflects higher private payor rate