GUARD Veterans’ Health Care Act

Cost Recovery from Medicare Plans: Medicare Advantage and prescription drug plan organizations must reimburse the Secretary for health care items or services provided to enrolled individuals, regardless of administrative requirements or documentation imposed by the plan (Section 2(a)(1)).

Streamlined Reimbursement Process: Third parties are required to pay "clean claims" within 45 days of receiving a claim or settlement, ensuring more efficient recovery of funds (Section 3(g)(1)).

Accountability via Interest and Penalties: If a third party fails to pay a claim within the required timeframe, they are required to pay interest to the United States (Section 3(g)(1)(3)). Furthermore, third parties that willfully fail to pay clean claims may face significant penalties, such as triple the amount of the claim or up to $50,000 (Section 3(j)(1)(2)(A)).

Protection Against Unpaid Claims: The United States is granted a cause of action for damages, which can be double the amount otherwise provided, in cases where a third party fails to provide payment or appropriate reimbursement (Section 3(j)(3)).

Increased Recovery for Non-Service-Connected Disabilities: The United States gains expanded rights to collect reasonable charges from third parties for care related to non-service-connected disabilities, including those resulting from tort liability (Section 3(1)(A)).

Restrictions on Settlement Distribution: Third parties are prohibited from distributing proceeds from a settlement, judgment, or award related to a recipient's care until the Department's claim has been satisfied (Section 3(i)(4)).

Strict Timelines for Payment Corrections: Third parties are not entitled to request a refund to correct a payment error if the request is submitted more than 18 months after the Department received the payment (Section 3(g)(5)).