The "Medicaid Provider Screening Accountability Act" requires states to screen Medicaid providers against a federal database to prevent payments to those terminated from Medicare or other state Medicaid programs.
Nicholas Langworthy
Representative
NY-23
The "Medicaid Provider Screening Accountability Act" mandates states to cross-check Medicaid providers against a federal database monthly, starting in 2028. This ensures providers terminated from Medicare or Medicaid/CHIP in other states are identified. The goal is to enhance provider screening processes within the Medicaid program.
Medicaid Provider Screening Gets Tougher in 2028: New Federal Checks Aim to Stop Cross-State Fraud
The "Medicaid Provider Screening Accountability Act" is pretty straightforward, aiming to tighten up how Medicaid providers are screened across the country. Here's the rundown:
Stopping Shady Providers
The core of the bill, found in Section 2, amends Section 1902(kk)(1) of the Social Security Act. Starting January 1, 2028, states must check a federal database every month. What are they checking for? Any Medicaid provider or supplier who's been kicked out of Medicare (that's Title XVIII) or booted from Medicaid/CHIP in another state. Basically, if you've been banned for shady practices in one place, this bill aims to make sure you can't just set up shop somewhere else and keep billing Medicaid.
Real-World Rollout
Imagine a doctor loses their license in Florida for, say, fraudulent billing. Currently, nothing automatically stops them from moving to Georgia and applying to be a Medicaid provider there. This bill changes that. Come 2028, Georgia's Medicaid agency would be required to check the federal database and see that this doctor is on the "no-go" list.
Who's Feeling the Change?
- Taxpayers: If this works as intended, it should mean less of our money going to fraudulent providers. Fewer bogus claims mean more funds are available for actual healthcare.
- Legit Providers: The vast majority of doctors and suppliers who play by the rules should see a fairer system. It levels the playing field a bit.
- State Medicaid Agencies: They'll have a new monthly task, but it could save them headaches (and dollars) in the long run.
The Catch (There's Always a Catch)
This all hinges on that federal database. For this to work, the database needs to be:
- Accurate: If a provider is wrongly listed as terminated, that's a problem.
- Up-to-date: If terminations aren't added quickly, there's a window for bad actors to slip through.
- Comprehensive: It needs to include data from all states and Medicare.
The Big Picture
This bill is playing catch-up with how things should work. It's a bit surprising this kind of cross-state check wasn't already mandatory. It connects to existing laws by amending the Social Security Act, the granddaddy of healthcare regulations. The challenge will be in the details – making sure that database is reliable and that states have the resources to do these checks effectively. If it works, it's a win for protecting taxpayer money and making sure Medicaid funds go where they're supposed to: helping people get the healthcare they need.