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OklahomaSB 1645Oklahoma 2026 Regular SessionSenateWALLET

Medicaid; establishing certain requirements and procedures for audits of providers; directing establishment of certain appeals. Effective date.

Sponsored By: Todd Gollihare (Republican)

Signed by Governor

Senate Committee

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 5 benefits, 0 costs, 0 mixed.

Clear timelines and appeals for audits

Starting January 1, 2027, you have at least 60 days to answer a preliminary audit report. The Authority must send a preliminary report within 120 days after the audit ends and a final report within 6 months after the preliminary report or the final appeal, whichever is later. The Authority sets a formal appeals process that contractors must use; after that, you can seek review by an administrative law judge, and then file in district court within 30 days if needed. The law bans retaliation for using these rights, and the Authority’s Board writes rules to carry them out.

No surprise or retroactive audit rules

Beginning January 1, 2027, the Authority and its contractors must share all audit policies, manuals, billing rules, and any changes with providers. They cannot recoup based on undisclosed or retroactively applied criteria, unless state or federal law requires it. All providers are audited under the same standards and parameters.

Fairer recoupment and corrected claim rules

Starting January 1, 2027, the Authority may recoup disputed funds only after the audit and all appeals are final, and only after the claim is corrected. Recoupment is limited to the extra amount above the corrected claim; if the corrected claim is paid the same day the correction is made, the full overpayment may be taken. A corrected claim is not an admission, and you have at least 60 days after an overpayment notice to file one. Clerical mistakes are not fraud without proof of intent, and approved, adjudicated claims cannot be reversed unless there was fraud or the law requires it.

Stronger limits on Medicaid provider audits

Beginning January 1, 2027, Medicaid audits face strict limits. You get at least 7 days’ notice, and no more than two audits a year unless it is a single identified-claim issue. Audits can only look back 24 months; samples are capped at the greater of 50 claims or 0.25% for long‑term care and 5% for others, and no statistical extrapolation is allowed. You may choose electronic or the same method for extra review (on‑site is only for long‑term care). Clinical audits must involve your licensing or oversight agency; the Authority cannot cite you if you followed that agency’s rules, and cannot base recoupments on extra documentation beyond state or federal law. These protections do not apply to alleged fraud, willful misrepresentation, or abuse.

Where recovered Medicaid payments go

Starting January 1, 2027, refunds from audit recoupments go to different places. For capitated services, refunds go to the contracted entity, which must report and handle funds under Authority rules. For fee‑for‑service, refunds go to the state agency that pays the state share, or to the Authority if it pays it.

Sponsors & Cosponsors

Sponsor

  • Todd Gollihare

    Republican • Senate

Cosponsors

  • Mark Lawson

    Republican • House

  • Danny Williams

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 109 • No: 7

House vote • 4/29/2026

Top_of_Page

Yes: 79 • No: 7

House vote • 4/13/2026

DO PASS

Yes: 10 • No: 0

House vote • 4/13/2026

DO PASS

Yes: 10 • No: 0

House vote • 4/1/2026

DO PASS

Yes: 5 • No: 0

House vote • 4/1/2026

DO PASS

Yes: 5 • No: 0

Senate vote • 3/25/2026

THIRD READING

Yes: 0 • No: 0

Senate vote • 2/9/2026

Top_of_Page

Yes: 0 • No: 0

Actions Timeline

  1. Approved by Governor 05/01/2026

    5/5/2026Senate

  2. Sent to Governor

    4/29/2026Senate

  3. Signed, returned to Senate

    4/29/2026House

  4. Enrolled, to House

    4/29/2026Senate

  5. Referred for enrollment

    4/29/2026Senate

  6. Signed, returned to Senate

    4/29/2026House

  7. Third Reading, Measure passed: Ayes: 79 Nays: 7

    4/29/2026House

  8. General Order

    4/29/2026House

  9. Coauthored by Representative(s) Williams

    4/13/2026House

  10. CR; Do Pass Health and Human Services Oversight Committee

    4/13/2026House

  11. Policy recommendation to the Health and Human Services Oversight committee; Do Pass Public Health

    4/1/2026House

  12. Referred to Public Health

    3/30/2026House

  13. Second Reading referred to Health and Human Services Oversight

    3/30/2026House

  14. First Reading

    3/26/2026House

  15. Engrossed to House

    3/26/2026Senate

  16. Referred for engrossment

    3/25/2026Senate

  17. Measure passed: Ayes: 46 Nays: 0

    3/25/2026Senate

  18. Title restored

    3/25/2026Senate

  19. General Order, Amended by Floor Substitute

    3/25/2026Senate

  20. Placed on General Order

    2/16/2026Senate

  21. Withdrawn from Appropriations committee

    2/16/2026Senate

  22. Referred to Appropriations

    2/9/2026Senate

  23. Title stricken

    2/9/2026Senate

  24. Reported Do Pass, amended by committee substitute Health and Human Services committee; CR filed

    2/9/2026Senate

  25. Coauthored by Representative Lawson (principal House author)

    2/3/2026Senate

Bill Text

  • Enrolled (final version)

    4/29/2026

    PDF

  • Floor (House)

    4/13/2026

    PDF

  • House Committee Report

    4/13/2026

    PDF

  • House Policy Committee Report

    4/1/2026

    PDF

  • Engrossed

    3/26/2026

    PDF

  • Committee Substitute

    2/17/2026

    PDF

  • Floor (Senate)

    2/17/2026

    PDF

  • Senate Committee Report

    2/9/2026

    PDF

  • Introduced

    1/13/2026

    PDF

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