Medicaid Integrity Improvement Act

Annual audits of high-risk Medicaid providers

This bill would require the statewide entity that runs the Medicaid fraud control 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 would happen at least once a year. Audits must be done in coordination with the HHS Inspector General and the State Medicaid agency and would look for possible fraud, waste, and abuse. The first annual report after the audit start date (and later reports) would have a summary of those audits and say how much overpayment was found and collected or referred. If an entity did not meet the audit requirement, the Secretary could still certify it if it sent and followed an approved corrective action plan. The bill defines "high-risk" providers to include those flagged under the federal screening rules and those with risk signs like abnormal billing, payment anomalies, ownership risks, prior audits, or credible fraud allegations.