This Act mandates that states verify the continued existence of Medicaid providers by checking the federal Death Master File at enrollment and quarterly thereafter to prevent fraudulent payments.
Scott Peters
Representative
CA-50
The Medicare and Medicaid Fraud Prevention Act mandates that states implement rigorous screening for all enrolled healthcare providers. Specifically, this legislation requires states to verify that all Medicaid providers are alive by checking the federal Death Master File upon enrollment and at least quarterly thereafter. This measure aims to prevent fraudulent payments made to deceased individuals or entities.
No More Ghost Doctors: Medicaid Mandates Quarterly Checks to Ensure Providers Are Still Alive
The newly proposed Medicare and Medicaid Fraud Prevention Act comes straight out of the gate with a simple, effective requirement aimed at keeping taxpayer dollars where they belong. Starting January 1, 2027, every state Medicaid program must add a critical step to its provider screening process: checking to see if the doctor or supplier they are paying is actually still alive.
The Dead Provider Problem
Section 2 of the Act mandates that when a state enrolls a healthcare provider or supplier into the Medicaid program, they must cross-reference that person against the federal Death Master File. This isn’t a one-and-done deal, either. States must repeat this check at least every three months for as long as that provider is enrolled and billing Medicaid. The idea is straightforward: stop paying benefits to deceased providers, which is a known source of improper payments, sometimes called “ghost doctors” or “zombie billing.”
What This Means for Your Wallet and Your State
For the average taxpayer, this is a clear win for program integrity. It’s the legislative equivalent of closing a loophole the size of a barn door. Currently, if a provider dies, it can sometimes take months or years for the state to catch up, during which time fraudulent or simply mistaken billings can continue. By making this quarterly check mandatory and tying it to a specific federal database, the bill establishes a clear, measurable standard for all states to follow. This should significantly reduce the amount of money wasted on improper payments.
For state Medicaid administrative offices, however, this means a new, recurring administrative task. They need to build the systems to handle the initial check during enrollment and then manage the quarterly sweep of their entire provider database against the Death Master File. While the benefit of preventing fraud far outweighs the cost, it’s still a technological and procedural lift that state agencies need to prepare for before the 2027 deadline. Essentially, it’s adding a layer of necessary due diligence to the existing screening requirements under the Social Security Act (Section 1902(kk)(1)), ensuring that the person getting paid isn't already six feet under.