Sponsor
Richard Lynn Scott
Senator · R-FL
Senator · R-FL
The bill strengthens Medicaid payment integrity and federal/state oversight (reducing improper payments) at the cost of added administrative and compliance burdens, greater audit-driven financial risk for providers and plans, and potential short-term disruption or privacy concerns for beneficiaries and providers.
State Medicaid agencies and Congress will get standardized, state-level annual reports on RAC methodologies, recovered overpayments, appeals, and recommendations, improving transparency and enabling better federal and state oversight and policy corrections.
Taxpayers, state governments, and Medicaid programs will likely see fewer improper Medicaid payments because the bill expands and standardizes recovery-audit activity (including managed care recoupment and coverage of recent and prior 4 fiscal years), protecting program integrity and reducing wasteful spending.
Managed care plans (MCOs/PIHPs/PAHPs) can use a defined internal review period (up to 18 months) to detect and correct payment errors before RAC action, which may reduce disputes and some administrative overhead for plans and providers.
State Medicaid agencies, managed care plans, and Medicaid contractors will face increased administrative and compliance costs to produce standardized reports, change contracts, add assurance processes, and expand RAC programs.
Hospitals, other providers, managed-care plans, and beneficiaries face greater financial uncertainty and cash-flow disruption from expanded audits and retrospective recoveries (including up to 4 years), which could delay payments, provoke retroactive clawbacks, and complicate continuity of care.
Providers and plans are likely to face more disputes, appeals, and litigation over recoveries and publicly reported overpayment data, straining provider–payer relationships and potentially causing smaller providers to exit Medicaid networks.
Based on analysis of 4 sections of legislative text.
Strengthens oversight and reporting of Medicaid RAC programs, requires review of managed care claims, standardized State reporting, a study and demonstration to expand State RAC participation, and a 5-year lookback audit rule.
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
Strengthens federal oversight, transparency, and state reporting for Medicaid Recovery Audit Contractor (RAC) programs and requires States to include managed care claim reviews in their payment-integrity efforts. It sets deadlines for CMS policies and State assurances, mandates standardized annual reporting and a multi-year demonstration to increase State participation, and fixes audit lookback periods for RAC contracts.