YourVoice.Now Summary
Transparency & AccountabilityEvery state would have to check its Medicaid program for fraud each year and fix weak spots within 90 days.
Transparency & Accountability
Each state would have to rank its biggest Medicaid fraud, waste, and abuse risks every year and estimate the money at stake. The checks would use existing federal and state data, and from October 2029 a new federal system that spots people enrolled in two states at once.
After each yearly check, a state would have 90 days to start a plan with deadlines and measurable goals to close the gaps it found. States would then report their progress to the federal health department every year.
More about this bill
Medicaid enrollees would see no direct change in their coverage. Instead, every state would have to check its Medicaid program for fraud each year. Medicaid is the health program for people with low incomes. The first check would be due within 1 year after the bill becomes law. Each check would cover payments to doctors, managed care plans, and the systems that sign people up. States would rank their biggest weak spots. They would also estimate how much money each one could lose over the next 12 months. Within 90 days of each check, a state would need a plan to fix the gaps, with deadlines and goals it can measure. States would report results to the federal health department every year. That department would set common rules for the checks by January 1, 2027, so states can be compared. It would then send Congress a yearly report on fraud trends and ideas for new laws. Meeting these rules would become one of the conditions every state Medicaid plan must meet.
Congressional Summary
Medicaid Fraud Prevention Act This bill requires state Medicaid programs to regularly assess their programs for fraud and take corrective actions. Specifically, states must complete a fraud risk assessment on at least an annual basis, implement a corrective action plan to address any identified vulnerabilities, and report on the results to the Centers for Medicare & Medicaid Services (CMS). The CMS must analyze this information and annually report the information to Congress. The fraud risk assessments must include a comprehensive assessment of the risks of fraud across the entirety of a state's Medicaid program, including with respect to managed care entities and eligibility and enrollment systems. The assessments must, to the extent practicable, utilize data from specified existing program integrity systems (e.g., Medicaid fraud control units). The CMS must issue guidelines on how states may identify areas that are at the highest risk of fraud.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2026-09-28
- Date Added
- 2026-10-03
- Source
- Congress.gov →
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