H.R. 10615
Medicaid Integrity Improvement Act
Summary:
• The bill, called the "Medicaid Integrity Improvement Act," amends title XIX of the Social Security Act to require State Medicaid fraud control units to conduct annual audits of high-risk providers and suppliers to identify potential fraud, waste, and abuse.
• High-risk providers and suppliers are defined as those designated as high categorical risk under existing screening processes, or those identified as high-risk based on factors such as abnormal billing patterns, prior audits, payment anomalies, ownership-related risk factors, or credible allegations of fraud.
• If an entity fails to meet the annual audit requirement, the Secretary may still certify it if the entity submits and implements an approved corrective action plan.
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• High-risk providers and suppliers are defined as those designated as high categorical risk under existing screening processes, or those identified as high-risk based on factors such as abnormal billing patterns, prior audits, payment anomalies, ownership-related risk factors, or credible allegations of fraud.
• If an entity fails to meet the annual audit requirement, the Secretary may still certify it if the entity submits and implements an approved corrective action plan.
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