PRIA Logo™
HR10636119th CongressWALLET

Medicaid Fraud Prevention Act

Sponsored By: Representative Rulli, Michael A. [R-OH-6]

Introduced

Summary

Requires yearly, mandatory fraud risk assessments across every State Medicaid program. This bill would force States to rank fraud, waste, and abuse risks, implement corrective action plans with measurable outcomes, and send annual reports to the HHS Secretary and to Congress.

Show full summary
  • States would have to finish an initial assessment within 1 year and then at least annually. Within 90 days after each assessment they must implement a corrective action plan with measurable outcomes and deadlines.
  • Assessments must cover fee-for-service, managed care, and eligibility and enrollment systems, and must estimate potential improper expenditures for each key vulnerability over at least a 12-month period.
  • The HHS Secretary must issue standard guidelines by January 1, 2027 to set risk categories, scoring criteria, and enable cross-State comparability. The Secretary will receive annual State reports and must send Congress an annual analysis of national fraud risk trends and recommendations.
  • Assessments should, to the extent practicable, rely on existing federal and State program integrity data and, beginning October 1, 2029, on a Secretary-established system to improve data comparability.

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

2 provisions identified: 2 benefits, 0 costs, 0 mixed.

Annual state Medicaid fraud checks

This bill would require each State Medicaid agency to finish a fraud risk assessment within 1 year of enactment and at least once a year after. Assessments would cover fee-for-service, managed care, and eligibility and enrollment systems. States would identify and rank major fraud, waste, and abuse risks and estimate possible improper spending for at least the 12 months after each assessment. Within 90 days after an assessment, States would implement a corrective action plan with measurable outcomes and deadlines. States would send a detailed report to the HHS Secretary within 1 year after the first assessment and annually after that.

HHS Medicaid fraud rules and report

This bill would require the HHS Secretary to issue standardized fraud risk guidance by January 1, 2027. The guidance would set common risk categories and scoring rules so State assessments can be compared across States. The Secretary would also send Congress an annual report starting within one year after the first State report. That report would analyze State findings, identify national fraud trends, evaluate corrective plans, and recommend legislative or administrative fixes.

Sponsors & CoSponsors

Sponsor

Rulli, Michael A. [R-OH-6]

OH • R

Cosponsors

  • Rep. Carter, Earl L. "Buddy" [R-GA-1]

    GA • R

    Sponsored 9/28/2026

  • Rep. Fischbach, Michelle [R-MN-7]

    MN • R

    Sponsored 9/28/2026

  • Rep. Taylor, David J. [R-OH-2]

    OH • R

    Sponsored 9/28/2026

  • Rep. Bentz, Cliff [R-OR-2]

    OR • R

    Sponsored 9/28/2026

  • Rep. Biggs, Andy [R-AZ-5]

    AZ • R

    Sponsored 9/28/2026

  • Rep. Finstad, Brad [R-MN-1]

    MN • R

    Sponsored 10/1/2026

Roll Call Votes

No roll call votes available for this bill.

View on Congress.gov
Back to Legislation