STOP FRAUD in Medicaid Act

Key Points

• This bill expands the role of state Medicaid fraud control units beyond investigating healthcare providers. Currently, these units focus on fraud by doctors and healthcare companies. The bill would require them to also investigate and prosecute individuals who lie on their Medicaid applications or while receiving benefits.
• The bill specifically broadens fraud investigations to cover the application process and ongoing receipt of Medicaid services, not just the provision of services. This means people who provide false information to get or keep Medicaid coverage could face legal action from state fraud units.
• State fraud units would gain authority to investigate individuals applying for or receiving Medicaid, in addition to their current authority over providers of services. This is a significant expansion of who these units can target.
• If enacted, states would have 180 days (about six months) to begin implementing the new investigative and prosecution powers. This gives states a window to adjust their fraud control operations and prepare for the expanded workload.