Sponsor
Richard Lynn Scott
Senator · R-FL
Senator · R-FL
The bill increases transparency and expands recovery of improper Medicaid payments—potentially saving taxpayer dollars and improving oversight—while imposing new administrative burdens and financial risks on states, plans, and providers that could disrupt care and prompt more disputes or access problems.
Taxpayers and the Medicaid program: the bill strengthens detection and recoupment of improper Medicaid payments (including expanded RAC coverage) so fewer improper dollars remain in the program.
Congress and state governments: the bill requires standardized, annual, state-level reporting and centralized information to Congress, improving oversight and enabling targeted policy or administrative fixes.
State governments: clearer, standardized visibility into which entities review and recover Medicaid payments and notification of RAC-exception SPA expirations gives states more predictable information to manage programs.
Hospitals, providers, managed-care plans, and beneficiaries: expanded audits and retrospective recoveries (including up to four years) will increase financial uncertainty, cash-flow risk, and may delay payments or trigger retroactive clawbacks that complicate continuity of care.
State governments, Medicaid contractors, plans, and providers: the bill imposes substantial new administrative and compliance costs (annual detailed reports, standardized formats, new contract language and assurances by Jan 1, 2028) that will divert staff time and resources.
Hospitals, providers and taxpayers: more public, itemized reporting of recovered overpayments and expanded recovery activity will likely increase appeals and litigation, strain provider–payer relationships, and could push smaller providers out of Medicaid, threatening access.
Based on analysis of 4 sections of legislative text.
Strengthens CMS oversight and transparency of State Medicaid RAC programs, requires State/MCO reporting and assurances, extends RAC reviews to managed-care payments, and mandates studies and a 5-year demonstration.
Official title: 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 Richard Lynn Scott · Last progress June 24, 2026
Requires the Department of Health and Human Services (HHS)/CMS to strengthen oversight, transparency, and reporting for State Medicaid Recovery Audit Contractor (RAC) programs. The bill forces states to report standardized RAC program details, ensure managed-care claim reviews, provide contract assurances with MCOs for RAC coordination, and expands audit-period rules and a federal study and demonstration to increase State participation in RACs. Sets deadlines for agency actions and state assurances (including actions within 120–180 days, annual State reports beginning within one year, and managed-care assurances by January 1, 2028), requires annual congressional reporting on program effectiveness, and directs a study and a 5-year demonstration to test ways to expand RAC participation and funding models.