Medicare and Medicaid Fraud Prevention Act
- Bill Number
- H.R. 2309
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-03-24: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-06-11T18:05:52Z
AI-Generated Summary
Purpose
The legislation, titled the Medicare and Medicaid Fraud Prevention Act, aims to strengthen fraud prevention in the Medicaid program by requiring states to verify that enrolled healthcare providers and suppliers are not deceased, thereby preventing improper payments to deceased individuals.
Key Provisions
- Provider Screening Requirement: Starting January 1, 2027, states must check the Death Master File (a federal database maintained by the Social Security Administration listing deceased individuals) for all providers and suppliers during their initial enrollment or re-enrollment (revalidation).
- Ongoing Checks: These checks must occur at least quarterly while the provider or supplier remains enrolled in Medicaid.
- Scope: Applies specifically to the Medicaid program under Title XIX of the Social Security Act, focusing on enrollment processes to ensure only living individuals can participate.
Significant Changes to Existing Law
- Amends Section 1902(kk)(1) of the Social Security Act (42 U.S.C. 1396a(kk)(1)), which already requires basic provider screening.
- Adds a new subparagraph (B) mandating the Death Master File checks, expanding beyond initial enrollment to include regular quarterly verifications.
- This builds on prior laws, such as the Bipartisan Budget Act of 2013, which defined the Death Master File, but makes its use mandatory and more frequent for Medicaid providers.
Potential Impacts
- Government Agencies: State Medicaid agencies will face increased administrative burdens and costs for conducting quarterly database checks, potentially requiring updates to enrollment systems. The federal government (via the Centers for Medicare & Medicaid Services) may see reduced fraud-related losses, saving taxpayer funds.
- Citizens: Medicaid beneficiaries could benefit indirectly from more efficient use of program funds, reducing waste and ensuring resources go to legitimate care. Taxpayers may experience lower overall program costs due to fraud prevention.
- International Relations: No direct impacts, as this is a domestic healthcare policy.
Main Stakeholders Affected
- State Medicaid Programs: Primarily responsible for implementing the screening, affecting their operations and budgets.
- Healthcare Providers and Suppliers: Includes doctors, hospitals, pharmacies, and other enrolled entities; they must ensure their status is up-to-date to avoid enrollment issues.
- Federal Government: The Centers for Medicare & Medicaid Services oversees compliance and could recover funds from improper payments.
- Medicaid Beneficiaries: Low-income individuals relying on the program, who gain from reduced fraud but are not directly involved.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances existing anti-fraud measures without creating new penalties, but non-compliance by states could lead to federal funding reductions under Medicaid rules. Relies on the Death Master File, a established tool, minimizing legal challenges.
- Constitutional: No apparent issues, as it involves federal regulation of a jointly funded program (Medicaid) where states have flexibility but must meet federal standards.
- Political: Introduced with bipartisan support (Democrats and Republicans), signaling broad agreement on fraud prevention. Could set a precedent for similar checks in other federal programs like Medicare, though the bill focuses only on Medicaid.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Peters, Scott H. [D-CA-50]
Cosponsors (7)
Rep. Evans, Gabe [R-CO-8], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Malliotakis, Nicole [R-NY-11], Rep. Kennedy, Mike [R-UT-3], Rep. Cuellar, Henry [D-TX-28], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Valadao, David G. [R-CA-22]
Recent Actions
- 2025-03-24: Referred to the House Committee on Energy and Commerce.
- 2025-03-24: Introduced in House
- 2025-03-24: Introduced in House
Bill Versions
- Medicare and Medicaid Fraud Prevention Act — issued 2025-03-24 — PDF (2 pages)