STOP FRAUD in Medicaid Act
This bill, introduced in the 119th Congress as H.R. 5364 and titled the STOP FRAUD in Medicaid Act, would amend the Social Security Act to require state Medicaid Fraud Control Units (MFCUs) to investigate and prosecute beneficiary fraud. Specifically, it broadens the scope of what counts as fraud to include actions by individuals applying for or receiving Medicaid benefits and services, not just providers. The changes modify the statutes to add references to applications for, and receipts of, benefits and services, thereby explicitly authorizing state MFCUs to pursue cases involving beneficiaries who commit fraud. The amendments would take effect 180 days after enactment. The bill carries the short title STOP FRAUD in Medicaid Act. In short, the bill moves Medicaid fraud enforcement to more directly target beneficiaries, expanding the grounds for investigation and prosecution by state fraud units and delaying enforcement by a fixed 180-day period after enactment.
Key Points
- 1Expands the role of State Medicaid Fraud Control Units to investigate and prosecute beneficiary fraud (applicants for, and recipients of, Medicaid benefits and services).
- 2Alters the text of title XIX (Social Security Act) to insert references to “application for” and “receipt of” benefits and services in relevant provisions.
- 3Provides a defined effective date: the amendments take effect 180 days after enactment.
- 4Includes a formal short title: the STOP FRAUD in Medicaid Act (also cited as the States Taking On Power For Redressing All Unlawful Deceits in Medicaid Act).
- 5The bill directs state MFCUs to focus on both investigation and prosecution of beneficiary fraud, expanding beyond provider-focused enforcement.