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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10645 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 10645
To amend title XIX of the Social Security Act to require the Secretary
of Health and Human Services to make uniformly available to States
certain standardized data analytic technologies to identify and prevent
fraud, waste, and abuse under Medicaid.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 1, 2026
Mr. Balderson (for himself, Mr. Bilirakis, Mrs. Harshbarger, 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 the Secretary
of Health and Human Services to make uniformly available to States
certain standardized data analytic technologies to identify and prevent
fraud, waste, and abuse under Medicaid.
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 ``Strengthening Medicaid Analytics to
Reduce Theft Act'' or the ``SMART Act''.
SEC. 2. REQUIRING THE AVAILABILITY OF CERTAIN STANDARDIZED DATA
ANALYTIC TECHNOLOGIES UNDER MEDICAID.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Availability of Standardized Data Analytic Technologies To
Identify Fraud.--
``(1) In general.--Beginning not later than 180 days after
the date of the enactment of this subsection, the Secretary
shall make available to each State standardized data analytic
technologies for purposes of identifying and preventing fraud,
waste, and abuse under the State plan (or waiver of such plan)
of such State under this title. In making such technologies
available, the Secretary shall--
``(A) ensure that such technologies are
interoperable with the mechanized claims processing and
information retrieval systems described in subsection
(a)(3)(A)(i), including Medicaid Management Information
Systems and State eligibility and enrollment systems,
and any other systems relevant to program integrity
under this title, as determined by the Secretary;
``(B) ensure that each State has the ability,
through the use of such technologies, to--
``(i) review the risk indicators described
in subparagraph (C)(i) and receive alerts
regarding fraud, waste, and abuse
vulnerabilities;
``(ii) access datasets and analytic outputs
for purposes of identifying potentially
improper billing, utilization, or enrollment
patterns;
``(iii) use any dashboard or other
investigative tools made available by the
Secretary for the purposes of program integrity
under this title;
``(iv) receive any program integrity alerts
that apply across more than 1 State or program;
``(v) conduct State-specific analyses and
generate State-level reports; and
``(vi) integrate analytic outputs from such
technologies into existing State program
integrity activities; and
``(C) use such technologies to--
``(i) establish risk indicators that
reflect the extent to which providers,
suppliers, and other entities participating in
more than 1 State plan under this title (or
waiver of such plan), or participating in
multiple Federal health care programs, may
present a risk for fraud, waste, or abuse,
based on--
``(I) billing data;
``(II) utilization data;
``(III) enrollment data; and
``(IV) any other relevant data
related to a Federal health care
program (as determined by the
Secretary); and
``(ii) provide States with actionable
alerts based on such risk indicators.
``(2) Technical assistance.--The Secretary shall provide
technical assistance and training to States on how to use the
technologies made available under paragraph (1).
``(3) Report.--Not later than 1 year after the date of
enactment of this subsection, and annually thereafter, the
Secretary shall submit to Congress a report on the technologies
described in paragraph (1). Each such report shall include the
following information:
``(A) The number of States with access to the
technologies made available under paragraph (1), and a
description of any barriers to such access.
``(B) The rate of utilization of such technologies
by each State, and a description of any barriers to
such utilization.
``(C) The number of instances of possible fraud,
waste, and abuse identified through the use of such
technologies, and an estimate of the amount of
overpayments identified and collected in connection
with such instances.''.
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