Medicaid Integrity Improvement Act

Annual audits of high-risk Medicaid providers

This bill would require the State entity that runs the statewide Medicaid integrity program to audit a statistically valid sample of high-risk Medicaid providers and suppliers. Audits would start no later than 1 year after enactment and must happen at least once each year. Audits would be done in coordination with the HHS Inspector General and the State Medicaid agency. The entity would include a summary of those audits, and a description of overpayments identified and collected or referred, in its first annual report after the 1-year date and in later reports. The bill would define “high-risk” providers as those the Secretary flags under the screening process or those the State identifies for abnormal billing, prior audit issues, ownership-related risks, payment anomalies, or credible fraud allegations. If a State entity misses the audit requirement, the Secretary could still certify it if the entity submits and implements a corrective action plan that meets the Secretary's standards.