Medicaid Integrity Improvement Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10615 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                               H. R. 10615

To amend title XIX of the Social Security Act to require State Medicaid 
             fraud control units to conduct annual audits.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2026

 Mr. Balderson (for himself, Mr. Bilirakis, Mr. Joyce of Pennsylvania, 
 and Mr. Pfluger) introduced the following bill; which was referred to 
                  the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL

 
To amend title XIX of the Social Security Act to require State Medicaid 
             fraud control units to conduct annual audits.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicaid Integrity Improvement 
Act''.

SEC. 2. REQUIRING STATE MEDICAID FRAUD CONTROL UNITS TO CONDUCT ANNUAL 
              AUDITS.

    Section 1903(q) of the Social Security Act (42 U.S.C. 1396b(q)) is 
amended--
            (1) in the matter preceding paragraph (1), by inserting ``, 
        subject to paragraph (8)(C),'' before ``annually recertifies''; 
        and
            (2) by adding at the end the following new paragraph:
            ``(8)(A) Beginning not later than the date that is 1 year 
        after the date of the enactment of this paragraph, and not less 
        frequently than annually thereafter, for purposes of conducting 
        the statewide program under paragraph (3), the entity, in 
        coordination with the Inspector General of the Department of 
        Health and Human Services and the State agency responsible for 
        administering the State plan under this title (as appropriate), 
        audits a statistically valid sample of high-risk providers and 
        suppliers for purposes of identifying potential fraud, waste, 
        and abuse.
            ``(B) Beginning with respect to the first annual report 
        submitted to the Secretary under paragraph (7) after the date 
        that is 1 year after the date of the enactment of this 
        paragraph, the entity shall include in such report a summary of 
        the audits conducted under this paragraph, including a 
        description of the extent to which overpayments were identified 
        and collected (or referred for collection) on the basis of such 
        audits.
            ``(C) In the case that the Secretary determines that an 
        entity has not met the requirement under subparagraph (A), the 
        Secretary may nonetheless certify (or recertify) the entity as 
        having met such requirement if the entity submits to the 
        Secretary and implements a corrective action plan meeting such 
        standards as the Secretary may specify.
            ``(D) For purposes of subparagraph (A), the term `high-risk 
        provider or supplier' means a provider or supplier 
        participating under the State plan (or a waiver of such plan) 
        that--
                    ``(i) is designated as a high categorical risk 
                under the process for screening providers and suppliers 
                under this title, as established by the Secretary under 
                section 1866(j)(2); or
                    ``(ii) is otherwise identified by the entity as 
                high-risk, based upon risk factors such as abnormal 
                billing patterns, prior audits, payment anomalies, 
                ownership-related risk factors (including ownership 
                changes, undisclosed ownership interests, or 
                affiliations with entities that have been sanctioned or 
                are subject to investigation), or credible allegations 
                of fraud.''.
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