H.R. 10636
Medicaid Fraud Prevention Act
Summary:
• The "Medicaid Fraud Prevention Act" amends title XIX of the Social Security Act to require states to annually complete comprehensive fraud risk assessments covering all components of their Medicaid state plans, including fee-for-service, managed care, and eligibility/enrollment systems
• States must implement a corrective action plan within 90 days of completing each assessment, including measurable outcomes and specific deadlines, and submit annual reports to the Secretary detailing vulnerabilities, estimated improper expenditures, and corrective actions taken
• The Secretary must establish assessment guidelines by January 1, 2027, and submit annual reports to Congress analyzing state findings, identifying national Medicaid fraud trends, evaluating corrective action implementation, and recommending legislative or administrative actions
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• States must implement a corrective action plan within 90 days of completing each assessment, including measurable outcomes and specific deadlines, and submit annual reports to the Secretary detailing vulnerabilities, estimated improper expenditures, and corrective actions taken
• The Secretary must establish assessment guidelines by January 1, 2027, and submit annual reports to Congress analyzing state findings, identifying national Medicaid fraud trends, evaluating corrective action implementation, and recommending legislative or administrative actions
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