SMART Act
Sponsored By: Representative Balderson, Troy [R-OH-12]
Introduced
Summary
This bill would make standardized data analytic technologies available to all States to detect and prevent Medicaid fraud, waste, and abuse. It would also require those tools to work with State claims and enrollment systems and come with training and technical help.
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- States would get interoperable analytics they can plug into Medicaid Management Information Systems and eligibility systems, with technical assistance and training and a 180-day deadline to start access after enactment.
- State program integrity teams would receive risk indicators, actionable alerts, dashboards, and datasets to find improper billing, unusual utilization, or enrollment patterns and to run State-specific analyses and reports.
- Providers, suppliers, and other entities that operate in more than one State or in multiple Federal health programs could be flagged by cross-state risk indicators based on billing, utilization, and enrollment data.
- The Department of Health and Human Services would report to Congress one year after enactment and then annually on State access, usage rates, instances of possible fraud, and estimated overpayments identified and collected.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Medicaid fraud detection tools for states
If enacted, this bill would require the HHS Secretary to give every State standardized data-analytics tools for Medicaid program integrity. The tools would be available no later than 180 days after enactment and must work with State claims, eligibility, enrollment, and other program systems. States would be able to see risk indicators, get alerts, access datasets and analytic outputs, use dashboards, run State-level reports, and integrate results into their investigations. The Secretary would set risk indicators using billing, utilization, enrollment, and related federal program data, and provide technical assistance and training. Not later than one year after enactment, and yearly after that, the Secretary would report to Congress on access, use, and instances of possible fraud and estimates of overpayments identified and collected. The bill names no specific funding amount.
Sponsors & CoSponsors
Sponsor
Balderson, Troy [R-OH-12]
OH • R
Cosponsors
Rep. Bilirakis, Gus M. [R-FL-12]
FL • R
Sponsored 10/1/2026
Rep. Harshbarger, Diana [R-TN-1]
TN • R
Sponsored 10/1/2026
Rep. Joyce, John [R-PA-13]
PA • R
Sponsored 10/1/2026
Rep. Pfluger, August [R-TX-11]
TX • R
Sponsored 10/1/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov