# 114-hr-4802: Medicaid Program Integrity Enhancement Act of 2016

114-hr-4802, Medicaid Program Integrity Enhancement Act of 2016, is a 114th Congress bill sponsored by Sen. Luján, Ben Ray [D-NM] (D-NM); status Referred to the Subcommittee on Health. (as of 2025-11-18).

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- As of: 2025-11-18
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 114-hr-4802
- Congress: 114
- Title: Medicaid Program Integrity Enhancement Act of 2016
- Status: Referred to the Subcommittee on Health.
- Introduced: 2016-03-17
- Sponsor: Sen. Luján, Ben Ray [D-NM] (D-NM)
- Cosponsors: 1
- Policy area: Health
- Touches household money: no
- Last recorded action: 2025-11-18

## Summary

Medicaid Program Integrity Enhancement Act of 2016 This bill amends title XIX (Medicaid) of the Social Security Act to require a state Medicaid agency to establish a process by which a provider may appeal a decision by the agency to suspend payment to the provider on the basis of credible fraud allegations. The Centers for Medicare & Medicaid Services (CMS) must revise specified regulations related to such suspensions in order to comply with due process requirements established by the bill. Specifically, a state Medicaid agency may not suspend payment until the agency: (1) consults with the state's Medicaid fraud control unit or, if the state has no such unit, with the state's attorney general; (2) certifies that it has considered whether the suspension will jeopardize beneficiary access and whether there is good cause not to suspend payment; and (3) furnishes the provider with the agency's reasons for finding no such good cause. Furthermore, the agency must periodically evaluate whether there is good cause to discontinue a suspension for which an investigation is pending. With specified exceptions, such good cause shall be deemed to exist if the investigation remains unresolved after a suspension has been in effect for 18 months. CMS must also revise specified regulations to provide that an allegation of fraud shall be considered credible only if the allegation has indications of reliability and the state Medicaid agency: (1) has reviewed all allegations, facts, and evidence carefully; (2) acts judiciously on a case-by-case basis; and (3) has considered the potential impact a payment suspension may have on beneficiary access to care.

## Cosponsors (1)

- Rep. Lujan Grisham, Michelle [D-NM-1] (D-NM), 2016-03-17T00:00:00.000Z

## Related bills

- 114-hr-5990: To grant the Congressional Gold Medal to the troops who defended Bataan during World War II.
- 114-hr-5942: Dialysis PATIENTS Demonstration Act of 2016
- 114-hr-5854: Safeguard Tribal Objects of Patrimony Act of 2016
- 114-hr-5844: ACTION for National Service Act
- 114-hr-5621: To posthumously award a Congressional Gold Medal to Lawrence Eugene "Larry" Doby in recognition of his achievements and contributions to American major league…
- 114-hr-5478: Pueblo de Cochiti Self-Governance Act

## Sources
- [114-hr-4802 on Congress.gov](https://www.congress.gov/bill/114th-congress/house-bill/4802)

## Related
- [114-hr-5990: To grant the Congressional Gold Medal to the troops who defended Bataan during…](https://policyrisk.com/legislation/114-hr-5990)
- [114-hr-5942: Dialysis PATIENTS Demonstration Act of 2016](https://policyrisk.com/legislation/114-hr-5942)
- [114-hr-5854: Safeguard Tribal Objects of Patrimony Act of 2016](https://policyrisk.com/legislation/114-hr-5854)
- [114-hr-5844: ACTION for National Service Act](https://policyrisk.com/legislation/114-hr-5844)
- [114-hr-5621: To posthumously award a Congressional Gold Medal to Lawrence Eugene "Larry" Dob…](https://policyrisk.com/legislation/114-hr-5621)
- [114-hr-5478: Pueblo de Cochiti Self-Governance Act](https://policyrisk.com/legislation/114-hr-5478)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/114-hr-4802 (as of 2025-11-18).