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Version 00 · Introduced in House · May 22, 2015
Fair Medical Audits Act of 2015
This bill amends title XVIII (Medicare) of the Social Security Act to modify requirements related to the identification and recovery of overpayments under Medicare.
A contract between the the Centers for Medicare & Medicaid Services (CMS) and a recovery audit contractor must require the contractor to provide a health care provider with: (1) specified identifying, legal, and logistical information; (2) an identification of any errors or underpayments discovered in the audit; and (3) a description of how any requested overpayment amount was calculated. Standards for extrapolation when used to determine overpayment amounts are established. CMS must require a contractor to give a provider at least 90 days' notice of identified code over-utilization and to reimburse a provider for the cost of producing certain documentation. The retrospective audit period is limited to two (rather than four) years.
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Recovery audit contractors must have staff with knowledge and experience related to clinical licensure and medical records, claims, and codes. A contractor that has excessive overturned determinations shall be subject to administrative penalty and, under specified circumstances, liable for attorneys' fees.
In the case of a provider seeking reconsideration of an overpayment determination, CMS may not recoup the overpayment until a decision has been rendered at the third level of appeal by an Administrative Law Judge. A recoupment based on a decision that is reversed on appeal must be returned to the provider within 30 days.
People & committees
Rep. Holding, George [R-NC-13] · R–NC
Legislative record
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Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
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Source last updated: Aug 12, 2025. Consult Congress.gov for the current record.
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