Sponsors (9)
The bill increases recovery, transparency, and accountability for improper Medicaid payments—potentially saving taxpayer dollars and correcting underpayments—while imposing new reporting, compliance, and audit burdens that could strain state agencies, providers, and managed‑care plans.
State Medicaid programs and taxpayers: expand recovery audits to claims paid by managed-care plans, increasing the chance of recouping improper Medicaid payments.
State Medicaid agencies and Congress: require standardized reporting (including pre-payment review savings and error‑reduction efforts) that can identify effective practices to lower improper payments and reduce waste.
Taxpayers and federal policymakers: get annual, state-level metrics and greater transparency about overpayments, appeals, and audit practices, enabling better oversight and policy decisions.
State Medicaid agencies and taxpayers: new standardized annual reporting, assurance requirements and implementation tasks will impose substantial administrative costs and staff burdens, and may divert state resources from care delivery.
Hospitals, providers and managed‑care plans: expanded audits and recoupments (including managed‑care‑paid claims) will raise compliance costs and can cause payment disruptions or slower cash flow for providers and plans.
Hospitals and providers: publishing state‑level overpayment and settlement data and stronger recovery activity could strain provider‑state relations and encourage more aggressive recoveries that harm provider revenues.
Based on analysis of 4 sections of legislative text.
Strengthens federal oversight of Medicaid RAC programs, requires managed-care inclusion, standardized state reporting, new deadlines, and limits lookback periods in new RAC contracts.
Official title: To implement recommendations of the Comptroller General of the United States for improving the Medicaid Recovery Audit Contractor program and identifying additional opportunities to recover Medicaid overpayments, and for other purposes.
Introduced June 24, 2026 by Gus Bilirakis · Last progress June 24, 2026
Requires states and HHS to strengthen oversight and transparency of Medicaid Recovery Audit Contractor (RAC) programs, expand RAC reviews to claims paid by managed care and prepaid plans, set deadlines and contract rules for audits, and increase standardized reporting to HHS and Congress. Establishes new timelines for HHS policy actions, annual federal reporting on RAC effectiveness, studies and a 5-year demonstration to boost state participation, and limits the lookback period for RAC recoveries in new contracts. Creates specific deadlines: HHS must issue policies within 180 days; states must provide managed-care contract assurances by January 1, 2028; states must begin standardized reporting within one year; and HHS must produce annual reports to Congress beginning December 31, 2027. The law also requires state RAC contracts entered 120 days after enactment to limit audits to the current fiscal year plus four prior fiscal years.