STOP FRAUD in Medicaid Act
The STOP FRAUD in Medicaid Act would broaden the authority of state Medicaid Fraud Control Units (MFCUs) to pursue fraud committed by Medicaid beneficiaries—i.e., applicants and recipients—as well as the existing focus on provider fraud and related abuses. By amending key provisions of the Social Security Act, the bill explicitly includes “application for, or receipt of” Medicaid benefits in the scope of MFCTU investigations and prosecutions. The changes are designed to ensure unscrupulous individuals who misrepresent, manipulate, or misuse eligibility or benefits can be investigated and charged. The amendments take effect 180 days after enactment. In short, the bill moves the fight against Medicaid fraud from primarily providers to include beneficiaries who fraudulently obtain or misuse benefits, expanding enforcement tools at the state level.
Key Points
- 1Expands MFCTU authority to beneficiary fraud: State Medicaid Fraud Control Units would investigate and prosecute fraud by individuals applying for or receiving Medicaid benefits, not just providers.
- 2Specific statutory amendments: The bill adds language requiring inclusion of “application for, or receipt of” in relevant sections of the Social Security Act (1903(q)(3) and 1902(a)(61)) to capture eligibility and benefit receipt in MFCTU cases.
- 3Scope expansion: The change covers fraud in the application process and in the ongoing receipt of benefits, broadening the types of conduct MFCTUs can pursue.
- 4Effective date: Provisions become operative 180 days after enactment of the bill.
- 5Short/long title: It is named the STOP FRAUD in Medicaid Act (full title: States Taking On Power For Redressing All Unlawful Deceits in Medicaid Act).