A bill to amend title XVIII of the Social Security Act to require medicare administrative contractors, unified program integrity contractors, and qualified independent contractors to pay the legal fees for certain durable medical equipment suppliers that were incorrectly denied payment.
About This Bill
Committee
Latest Action · July 22, 2026
Read twice and referred to the Committee on Finance.
The FAIR DME Appeals Act requires Medicare contractors to pay the legal fees and litigation costs of small durable medical equipment suppliers who successfully win appeals against wrongful payment denials. When an administrative law judge determines that a contractor's initial denial was clearly erroneous, unsupported by evidence, or violated applicable rules, that contractor must cover the supplier's reasonable attorney fees and court costs from all stages of the appeal process. The bill creates a 30-day application period for suppliers to request these fee awards and gives contractors 30 days to respond, with an administrative law judge issuing a final determination within 60 days. However, suppliers remain ineligible for fee awards if their denials resulted from their own failure to submit required documentation, non-compliance with billing requirements, or the contractor's correct application of rules that were later changed. The Secretary must issue implementing regulations within two years, with the law taking effect for contracts entered into on or after January 1 of the following year.
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