PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the House Committee on Energy and Commerce.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Balderson, Troy [R-OH-12] · R–OH
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
Referred to the House Committee on Energy and Commerce.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Oct 8, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-09-28 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Medicaid Integrity Improvement Act would require state Medicaid fraud control units to audit a statistically valid sample of high-risk providers and suppliers each year. The audits would look for potential fraud, waste, and abuse. Units would report audit results, including whether overpayments were identified and collected or referred for collection.
This Act may be cited as the Medicaid Integrity Improvement Act.
Requiring State Medicaid fraud control units to conduct annual audits
audits a statistically valid sample of high-risk providers and suppliers for purposes of identifying potential fraud, waste, and abuse.
the entity shall include in such report a summary of the audits conducted under this paragraph, including a description of the extent to which overpayments were identified and collected (or referred for collection) on the basis of such audits.
Audits would have to begin within one year after enactment and occur at least annually afterward. Units would coordinate with the Department of Health and Human Services Inspector General and, as appropriate, the state agency administering Medicaid.
Beginning not later than the date that is 1 year after the date of the enactment of this paragraph, and not less frequently than annually thereafter, for purposes of conducting the statewide program under paragraph (3), the entity, in coordination with the Inspector General of the Department of Health and Human Services and the State agency responsible for administering the State plan under this title (as appropriate), audits a statistically valid sample of high-risk providers and suppliers
The high-risk definition would cover providers and suppliers participating in a state's Medicaid plan or a waiver of that plan if they are designated as a high categorical risk under the federal provider-screening process.
the term high-risk provider or supplier means a provider or supplier participating under the State plan (or a waiver of such plan) that— (i) is designated as a high categorical risk under the process for screening providers and suppliers under this title, as established by the Secretary under section 1866(j)(2)
Units could also identify participating providers or suppliers as high risk using factors such as unusual billing, previous audits, payment irregularities, ownership changes, undisclosed ownership interests, ties to sanctioned entities or entities under investigation, or credible fraud allegations. The listed factors are examples, rather than an exhaustive list.
or (ii) is otherwise identified by the entity as high-risk, based upon risk factors such as abnormal billing patterns, prior audits, payment anomalies, ownership-related risk factors (including ownership changes, undisclosed ownership interests, or affiliations with entities that have been sanctioned or are subject to investigation), or credible allegations of fraud.
Starting with the first annual report submitted to the Secretary after the one-year anniversary of enactment, units would have to summarize their audits and describe the extent to which resulting overpayments were identified, collected, or referred for collection.
Beginning with respect to the first annual report submitted to the Secretary under paragraph (7) after the date that is 1 year after the date of the enactment of this paragraph, the entity shall include in such report a summary of the audits conducted under this paragraph, including a description of the extent to which overpayments were identified and collected (or referred for collection) on the basis of such audits.
If the Secretary determined that a unit had failed to meet the audit requirement, the Secretary could still certify or recertify it as meeting that requirement if it submitted and implemented a corrective action plan meeting standards the Secretary may set. This exception would be discretionary, not automatic. The bill would also insert a reference making the existing annual-recertification language subject to this exception.
in the matter preceding paragraph (1), by inserting , subject to paragraph (8)(C), before annually recertifies
In the case that the Secretary determines that an entity has not met the requirement under subparagraph (A), the Secretary may nonetheless certify (or recertify) the entity as having met such requirement if the entity submits to the Secretary and implements a corrective action plan meeting such standards as the Secretary may specify.
The supplied official-actions snapshot, updated October 8, 2026, records introduction in the House and referral to the House Committee on Energy and Commerce on September 28, 2026.
Source snapshot updated 2026-10-08T16:31:55Z. 2026-09-28: Referred to the House Committee on Energy and Commerce. 2026-09-28: Introduced in House
A closer look
Reviewed version: Introduced in House · 2026-09-28. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials. Member requests, earmark disclosures, committee reports, and conference materials were not supplied.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow carve-out, special exemption, or preferential treatment warranting a finding under the supplied definition was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Oct 8, 2026. How PlainBill uses AI