Axne, Bergman Introduce Bipartisan Protecting Patients from Medicaid Fraud Act

July 28, 2021
Press Release

Yesterday, Reps. Cindy Axne (IA-03) and Jack Bergman (MI-01) introduced the Protecting Patients from Medicaid Fraud Act, a bipartisan bill to improve oversight of Medicaid, prevent improper payments and waste, and protect patients from fraud.

This legislation is based on recommendations from the Government Accountability Office (GAO), a nonpartisan agency that works to improve the operations and fiscal responsibility of the federal government.

“The oversight of health care providers in Medicaid is so inefficient and convoluted that its allowed more than $35 billion in improper payments in just one year. As health care costs continue to rise, we need to crack down on providers that’re defrauding patients and unlicensed professionals lining their pockets at the expense of American taxpayers who’re paying higher and higher costs for care,” said Rep. Axne. “After fighting to make government more efficient and accountable at the state level for nearly a decade, I’ve been working in Congress to find commonsense solutions that will reduce waste, cut red tape, and save taxpayers money. This bipartisan bill is one such solution — and would help save billions of taxpayer dollars through simple enforcement of the laws already on the books.”

“While states are required by law to screen health providers enrolled in Medicaid, we have no system in place today to check if states are following through,” said Rep. Bergman. “This means billions of dollars every year may be going to providers that defraud patients, fail to meet health and safety standards, or operate without medical licenses. With nearly $500 billion of federal spending going towards Medicaid annually, our current level of oversight and accountability is unacceptable. I am proud to introduce this important bill with Representative Axne to improve Medicaid and protect patients nationwide.”

Under federal law, states must screen health providers before and every five years after enrolling them in Medicaid. This ensures providers are properly certified and ultimately protects patients from fraud.

However, the agency that administers the Medicaid program, the Centers for Medicare and Medicaid Services (CMS) does not conduct any nationwide screenings to certify compliance with these eligibility requirements. They instead rely on optional consultations with states. This patchwork of data makes it impossible to check compliance and prevent improper payments.

The Protecting Patients from Medicaid Fraud Act would expand CMS’s review of provider eligibility compliance to include all states, not just those participating in optional consultations. It would also give CMS the tools needed to monitor the progress of states currently working to become compliant.