Medicare and Medicaid Fraud Prevention Act
This bill amends Title XIX of the Social Security Act to strengthen Medicaid provider screening. Starting January 1, 2027, when a provider or supplier enrolls in Medicaid (or revalidates their enrollment) and at least quarterly while they remain enrolled, the state must perform a Death Master File check to determine whether the provider is deceased. The Death Master File is defined by the Bipartisan Budget Act of 2013. The aim is to prevent improper payments and fraud by ensuring that a provider being paid through Medicaid is alive and legitimately enrolled. In effect, the bill adds ongoing, regular verification that Medicaid providers are not deceased, which could help detect and block fraudulent payments or misuse of a provider’s identity. The bill is introduced in the House and would apply specifically to Medicaid enrollment and revalidation processes, with a clear implementation timeline.
Key Points
- 1Adds “Additional provider screening” by requiring a Death Master File check for Medicaid providers and suppliers.
- 2Checks must occur as part of enrollment or revalidation of enrollment and must be conducted not less frequently than quarterly during the enrollment period.
- 3Effective date for the new requirement begins January 1, 2027.
- 4The Death Master File reference is the definition from section 203(d) of the Bipartisan Budget Act of 2013.
- 5The change is limited to Medicaid (Title XIX) and does not alter Medicare screening requirements in this text.