Reps. Torres, Clarke Introduce Bill to Protect Patients from Medicare Clawbacks

WASHINGTON, D.C. — Today, Reps. Ritchie Torres (NY-15) and Yvette D. Clarke (NY-09) introduced the No Medicare Clawbacks Act, legislation designed to protect patients from being forced to repay health care costs after insurers retroactively change who was responsible for coverage.

The bill would prohibit group health insurers from clawing back payments for medical services when a patient is later found to have been retroactively enrolled in Medicare, provided the individual paid their insurance premiums in full.

The legislation addresses a problem that occurs when individuals become eligible for Medicare coverage retroactively, often months after they received medical care. In some cases, group health plans initially pay for the care, only to later attempt to recover those payments from providers or patients after discovering the individual had retroactive Medicare eligibility. These clawbacks can create confusion for patients and unexpected financial liability long after treatment has occurred.

Under this bill, group health plans that initially pay for medical services would not be allowed to later recoup those payments solely because the patient was retroactively enrolled in Medicare Part A. The protection would apply when the services were provided during a period of retroactive Medicare coverage and the individual had remained current on their required premium contributions to the employer-sponsored health plan at the time the care was delivered.

“Patients should not be caught in the middle of bureaucratic disputes between insurers and Medicare,” said Rep. Torres. “When someone pays their premiums and receives medical care in good faith, they should not face the threat of retroactive payment demands months or years later. The No Medicare Clawbacks Act protects patients from being penalized for administrative complications they cannot control.”

“No one should face surprise medical bills because of a technicality. When patients pay their premiums, and healthcare providers deliver care in good faith, insurers should not be allowed to claw back payments months later because Medicare coverage was retroactively backdated without the patient’s knowledge. I am proud to introduce the No Medicare Clawbacks Act with my colleague, Rep. Torres,” said Rep. Clarke.  “This commonsense legislation protects patients and providers by preventing unfair payment clawbacks and bringing greater certainty, fairness, and accountability to the Medicare Secondary Payer system, while safeguarding seniors, workers, and healthcare providers alike, ensuring that Americans and New Yorkers can focus on their health without fear of being penalized.” 

The legislation amends title XVIII of the Social Security Act, the statute governing Medicare, to establish clear protections against retroactive payment clawbacks. By preventing group health plans from reclaiming payments after the fact, the bill aims to create greater stability for patients, providers, and plans, and it ensures that individuals who pay their premiums and meet their obligations aren’t exposed to unexpected medical debt over administrative timing issues outside their control.

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