H.R. 10636: Medicaid Fraud Prevention Act

This bill requires state Medicaid programs to regularly assess their programs for fraud and take corrective actions.

Specifically, states must complete a fraud risk assessment on at least an annual basis, implement a corrective action plan to address any identified vulnerabilities, and report on the results to the Centers for Medicare & Medicaid Services (CMS). The CMS must analyze this information and annually report the information to Congress.

The fraud risk assessments must include a comprehensive assessment of the risks of fraud across the entirety of a state's Medicaid program, including with respect to managed care entities and eligibility and enrollment systems. The assessments must, to the extent practicable, utilize data from specified existing program integrity systems (e.g., Medicaid fraud control units). The CMS must issue guidelines on how states may identify areas that are at the highest risk of fraud.

Written by the Congressional Research Service, Library of Congress.