GUARD Veterans’ Health Care Act

Streamlined Reimbursement for 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 additional administrative requirements or documentation the plan might typically impose (Section 2(a)(1)).

Enhanced Recovery for Non-Service-Connected Disabilities: The United States gains an expanded right to recover reasonable charges for care or services furnished for non-service-connected disabilities, including those resulting from tort liabilities (Section 3(1)(A)).

Protection Against Delayed Payments: Third parties are required to pay clean claims within 45 days of receiving a claim or settlement, ensuring a faster reimbursement process for the Department (Section 3(5)(g)(1)).

Accountability for Third-Party Delays: If a third party fails to comply with required timelines, they are required to pay interest to the United States (Section 3(5)(g)(1)(3)).

Penalties for Non-Compliance: To ensure third parties follow the rules, the bill establishes civil penalties for non-compliance and higher penalties—potentially triple the claim amount or up to $50,000—for those who willfully refuse to pay clean claims (Section 3(5)(j)).

Increased Burden on Third-Party Payers: Third parties, such as insurance providers or entities responsible for tort damages, face new, strict requirements to pay claims within specific timeframes or face interest and civil penalties (Section 3(5)(g) and Section 3(5)(j)).

Strict Liability and Penalty Risks: Entities that "willfully" fail to pay a clean claim face significant financial consequences, including paying triple the amount of the claim (Section 3(5)(j)(2)(A)).

Restrictions on Recovery Requests: A third party cannot request a refund to correct a payment error if they submit that request more than 18 months after the Department received the payment (Section 3(5)(g)(5)).