H.R. 2309: Medicare and Medicaid Fraud Prevention Act

This bill, known as the Medicare and Medicaid Fraud Prevention Act, is aimed at strengthening the screening processes for Medicaid providers. The main changes proposed in the bill include:

Provider Screening Updates

The bill amends existing regulations about how states screen providers who want to enroll in or revalidate their status under the Medicaid program. The specific amendments include:

• Replacing the phrase “The State” with updated language regarding the responsibilities of states in the screening process.
• Adding a requirement that starting from January 1, 2027, states must check the Death Master File on a quarterly basis. This file contains the names of individuals who have been identified as deceased.

Purpose of the Changes

The intent behind these changes is to help ensure that providers or suppliers involved in the Medicaid program are active and legitimate. By checking the Death Master File, it aims to prevent fraud related to deceased individuals being incorrectly listed as active providers.

Implementation Timeline

The amendment specifies that the new screening requirements will come into effect on January 1, 2027. This gives states a timeline to adjust their enrollment and revalidation processes to comply with the new requirements.

Impact on States

States will bear the responsibility for enforcing these new screening measures, which may require updates to their current systems and processes for managing Medicaid provider enrollments. This could involve new administrative costs and resource allocation to ensure compliance with the new regulations.

Sector Implications

The bill is part of a broader effort to combat fraud in healthcare programs and could strengthen the integrity of Medicaid by ensuring that payments are made only to valid providers.

Relevant Companies

None found.