Medicaid Integrity Improvement Act

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Introduced

In Committee

Passed One Chamber

Passed Both Chambers

Signed into Law

Referred to the House Committee on Energy and Commerce.

State Medicaid fraud units would begin yearly audits of high-risk providers to fight waste.

State Medicaid fraud units would start yearly audits of high-risk healthcare providers and suppliers. This aims to find and prevent waste and abuse in Medicaid, giving state units new tasks and increasing checks on some providers.

What Would Change

Today, state Medicaid fraud control units are recertified each year, but they are not specifically required by federal law to conduct annual audits of high-risk healthcare providers. If this bill passes, these state units would be required to conduct yearly audits of a statistically valid sample of high-risk providers and suppliers. They would also need to report on these audits, including any overpayments found, to the Secretary of Health and Human Services.

Key Provisions

Requires state Medicaid fraud control units to conduct yearly audits of high-risk healthcare providers and suppliers to find fraud, waste, and abuse.
Defines "high-risk provider or supplier" to include those flagged by existing screening or identified by states due to unusual billing or ownership issues.
Requires state Medicaid fraud control units to include a summary of these audits, including any overpayments found, in their yearly reports to the Secretary of Health and Human Services.
Lets the Secretary of Health and Human Services approve state units even if they miss audit requirements, as long as they have a plan to fix the problem.

View on Congress.gov

HR 10625 · 119th Congress · AI Summary by gemini-2.5-flash · 9/10

Medicaid Integrity Improvement Act

What Would Change

Key Provisions

Lobbying Activity