PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the House Committee on Energy and Commerce.
Congressional Research Service
Version 00 · Introduced in House · Sep 28, 2026
Medicaid Fraud Prevention Act
This bill requires state Medicaid programs to regularly assess their programs for fraud and take corrective actions.
Specifically, states must complete a fraud risk assessment on at least an annual basis, implement a corrective action plan to address any identified vulnerabilities, and report on the results to the Centers for Medicare & Medicaid Services (CMS). The CMS must analyze this information and annually report the information to Congress.
The fraud risk assessments must include a comprehensive assessment of the risks of fraud across the entirety of a state's Medicaid program, including with respect to managed care entities and eligibility and enrollment systems. The assessments must, to the extent practicable, utilize data from specified existing program integrity systems (e.g., Medicaid fraud control units). The CMS must issue guidelines on how states may identify areas that are at the highest risk of fraud.
People & committees
Rep. Rulli, Michael A. [R-OH-6] · 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.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 2, 2026. Consult Congress.gov for the current record.
AI Conversation Starters
Choose a perspective, copy a prompt, and paste it into your preferred AI. Each prompt includes the bill version and available official source links, and asks for counterarguments as well as supporting evidence.
Analyze H.R.10636 as objectively as possible. Explain its main provisions, who would be affected, possible benefits and harms, implementation, exceptions, and uncertainties. Present the strongest arguments for and against it, and identify evidence needed to assess its public impact.
Examine H.R.10636 through a progressive lens, focusing on fairness, access, economic inequality, and effects on vulnerable communities. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and distinguish stated goals from demonstrated outcomes.
Examine H.R.10636 through a conservative lens, focusing on fiscal responsibility, institutional stability, federalism, and the scope of government. Explain potential benefits, costs, and unintended consequences. Consider the strongest counterarguments and any provisions that challenge this perspective.
Examine H.R.10636 through a civil-liberties and limited-government lens. Consider individual rights, privacy, voluntary choice, accountability, and government power. Explain tradeoffs, possible safeguards, and the strongest counterarguments without assuming the proposal is beneficial or harmful.
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 proposal would require states to assess fraud risks throughout their Medicaid programs every year and implement plans to address weaknesses they find. Reviews would cover payments for care and systems that determine eligibility and enrollment. States would report their findings and corrective actions to the federal Secretary, who would report to Congress. These are proposed requirements; the supplied record does not establish enactment.
the State shall— (A) not later than 1 year after the date of the enactment of this subsection and not less frequently than annually thereafter, complete a fraud risk assessment as described in paragraph (2);
(B) not later than 90 days after completing such an assessment, implement a corrective action plan to address any vulnerabilities identified in such assessment
including with respect to medical assistance provided on a fee-for-service basis, medical assistance provided through a managed care entity, and eligibility determination and enrollment systems
submit to the Secretary a report that includes the information specified in paragraph (3) with respect to the preceding year.
the Secretary shall submit to Congress a report
Source snapshot updated 2026-10-02T22:05:06Z. 2026-09-28: Referred to the House Committee on Energy and Commerce. 2026-09-28: Introduced in House
Section 1 would name the legislation the Medicaid Fraud Prevention Act.
1. Short title This Act may be cited as the Medicaid Fraud Prevention Act.
Section 2 would add a state compliance requirement to section 1902 of the Social Security Act. Each state would have to complete its first fraud risk assessment within one year after enactment and repeat it at least annually.
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
(91) provide that the State shall comply with the fraud risk assessment requirements under subsection (zz).
(A) not later than 1 year after the date of the enactment of this subsection and not less frequently than annually thereafter, complete a fraud risk assessment as described in paragraph (2);
Within 90 days after completing each assessment, a state would have to implement a plan to address identified weaknesses. The plan would need measurable outcomes and specific deadlines for completing corrective actions.
(B) not later than 90 days after completing such an assessment, implement a corrective action plan to address any vulnerabilities identified in such assessment that includes measurable outcomes and specific deadlines with respect to the completion of corrective actions under such plan;
Assessments would cover every component of the state's Medicaid plan, including arrangements operating under waivers of that plan. Coverage would include payments for individual services, care provided through managed care organizations, and eligibility and enrollment systems—including systems operated for the state that verify eligibility or check it again.
a comprehensive assessment of fraud risks across all components of the State plan (and any waiver of such plan), including with respect to medical assistance provided on a fee-for-service basis, medical assistance provided through a managed care entity, and eligibility determination and enrollment systems (including systems operated by or on behalf of the State for the purposes of eligibility verification and redetermination) under such plan (or waiver)
States would have to use existing federal and state program oversight data to the extent practicable. Listed sources include payment-error measurements, Medicaid statistical information, managed care service records, state fraud-control or other oversight data, and public assistance reporting data. Beginning October 1, 2029, the list would also include the Secretary's system established under subsection (uu), whose contents are not supplied.
(i) to the extent practicable, uses data from existing Federal and State program integrity systems, including— (I) the Payment Error Rate Measurement program (or any successor program); (II) the Transformed Medicaid Statistical Information System (or any successor system); (III) managed care encounter data; (IV) data from a State medicaid fraud control unit (as defined in section 1903(q)) or another program integrity activity; (V) the Public Assistance Reporting Information System (PARIS) (or any successor system); and (VI) beginning October 1, 2029, the system established by the Secretary under subsection (uu);
Each assessment would identify and rank the most significant fraud, waste, and abuse risks. For each risk, it would estimate potential improper spending, including improper payments, for at least the 12 months beginning when the assessment is completed. These would be estimates of possible spending errors, not findings that those amounts had already been lost.
(ii) identifies and ranks the most significant fraud, waste, and abuse vulnerabilities of such plan (or waiver); (iii) estimates the amount that could potentially be improperly expended under such plan (or waiver) due to each such vulnerability, including any improper payments associated with each such vulnerability, with respect to, at minimum, the 12-month period beginning on the date on which such assessment is completed;
States would also have to evaluate whether their existing oversight tools work effectively, identify gaps in data sharing, oversight, and enforcement, and follow the Secretary's assessment guidelines.
(iv) evaluates the effectiveness of existing program integrity tools under such plan (or waiver); (v) identifies gaps in data sharing, oversight, and enforcement with respect to fraud, waste, and abuse under such plan (or waiver); and (vi) follows the guidelines established by the Secretary under subparagraph (B).
By January 1, 2027, the Secretary would have to establish common risk categories and assessment criteria so states' results could be compared. The guidelines would cover eligibility decisions, provider enrollment, claims processing, and managed care. Risks would be scored and prioritized using their likelihood and estimated potential improper spending.
Not later than January 1, 2027, the Secretary shall establish guidelines that— (i) identify and define standardized categories of fraud, waste, and abuse risk across State plans (and waivers of such plans), including with respect to eligibility determinations, provider enrollments, claims processing, and managed care; (ii) establish criteria for the identification, scoring, and prioritization of categories of risk identified under clause (i) on the basis of the likelihood of such risks and estimates of potential improper expenditures (as described in subparagraph (A)(iii)) due to such risks; and (iii) enable fraud risk assessments completed under this subsection by different States to be effectively compared.
Each state would have to submit its first report to the Secretary within one year after completing its first assessment, then report annually. Reports would cover the preceding year and include assessment results, major weaknesses, estimated potential improper spending, corrective actions taken or planned, and progress in addressing weaknesses.
(C) not later than 1 year after the completion of the first fraud risk assessment under this subsection, and annually thereafter, submit to the Secretary a report that includes the information specified in paragraph (3) with respect to the preceding year.
(3) Information specified For purposes of paragraph (1), the information specified in this paragraph is— (A) the results of any fraud risk assessments conducted under paragraph (1)(A); (B) the most significant fraud, waste, and abuse vulnerabilities identified under such assessments; (C) the potential improper expenditures (as described in paragraph (2)(A)(iii)) estimated under such assessments; (D) corrective actions taken or planned to be taken under paragraph (1)(B) with respect to such vulnerabilities; and (E) an explanation of any progress made in addressing such vulnerabilities.
Within one year after receiving the first state report, the Secretary would have to report to Congress, then do so annually. Each report would analyze the preceding year's state findings, identify national Medicaid fraud-risk trends, evaluate states' implementation of corrective plans, and recommend legislative or administrative action.
(4) Annual report to Congress Not later than 1 year after the date on which the first report under paragraph (1)(C) is submitted to the Secretary, and annually thereafter, the Secretary shall submit to Congress a report that, with respect to the preceding year— (A) analyzes the findings from reports submitted to the Secretary under such paragraph; (B) identifies national trends with respect to Medicaid fraud risk; (C) evaluates State implementation of corrective action plans implemented under paragraph (1)(B); and (D) includes recommendations for legislative or administrative action to address fraud, waste, and abuse vulnerabilities identified in such reports.
The supplied actions snapshot, updated October 2, 2026, records introduction in the House and referral to the House Committee on Energy and Commerce on September 28, 2026.
Source snapshot updated 2026-10-02T22:05:06Z. 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 appropriations policy rider was identified in 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 in the complete supplied introduced text. This conclusion is limited to that version; earmark disclosures and accompanying committee 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 was identified in 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 2, 2026. How PlainBill uses AI