Sponsors (10)
The bill increases transparency and expands audit authority to help states and taxpayers recover improper Medicaid payments and identify best practices, but it imposes new reporting and implementation costs on states and raises compliance and cash‑flow risks for providers while some benefits are delayed by a multi‑year demonstration.
State Medicaid agencies and Congress will get standardized, annual state-level RAC data and metrics, increasing transparency and enabling better federal and state oversight to identify and reduce improper payments.
State Medicaid programs and taxpayers could recover more improper payments because recovery audits will explicitly cover managed-care-paid claims and HHS will run a demonstration to identify barriers and solutions to wider RAC adoption.
Hospitals, Medicaid plans, and other providers will have more predictable liability because the bill sets clearer deadlines for RAC exceptions and limits retrospective audits to the current fiscal year plus four prior years.
State Medicaid agencies will face recurring administrative burdens and staffing costs to collect, standardize, and submit new annual RAC reports and to revise oversight systems and contracts.
Hospitals, managed‑care plans, and providers will incur higher compliance costs and may experience cash‑flow disruptions from expanded audits and recoupment activity (including within managed care).
Publishing state‑level overpayment, underpayment, and settlement data may strain provider–state relationships and could incentivize more aggressive recoveries that threaten provider revenues and access to care.
Based on analysis of 4 sections of legislative text.
Strengthens oversight and reporting of Medicaid Recovery Audit Contractor programs, requires managed-care audit coverage, sets lookback limits, and mandates HHS studies and demonstrations.
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 HHS and states to strengthen oversight, reporting, and limits for Medicaid Recovery Audit Contractor (RAC) programs. Sets deadlines for state assurances and contract terms, mandates annual and state-level reporting to Congress, creates studies and a 5-year demonstration to boost state RAC participation, and tightens time limits on audit lookbacks. Imposes new requirements on State Medicaid plans and managed-care contracts to ensure audits cover managed-care claims, requires annual state reporting on RAC activity, and directs HHS to publish findings and recommendations about RAC effectiveness and barriers to state participation.