Putting an N to Learing about Fraud Act

Summary

Requires child-care payments to be tied to recorded attendance (not just enrollment), makes child-care providers keep attendance and service records for seven years and available for federal audit, and creates new federal and state reporting triggers to flag large year-over-year spikes in payments or provider counts in a ZIP code/county across Medicare, ACA Exchange plans, Medicaid, and CHIP. Also directs OMB to issue guidance to agencies to recover improper payments and requires Inspector General reports to show amounts of improper payments actually recovered.

• Child-care payments must be made on the basis of recorded attendance, not merely enrollment.
• Child-care providers receiving federal funds must keep attendance and service records for 7 years and make them available for audit.
• HHS must be notified within 60 days when Medicare, Exchange plans, Medicaid, or CHIP see >100% single-year increases in payments or provider counts in a ZIP code/county.
• Exchanges must submit annual payment and provider data to HHS to enable spike detection.
• HHS OIG must annually audit programs with at least a 400% increase in payments or providers over a 5-year period, starting no later than 5 years after enactment.
• OMB must issue guidance to agencies to ensure recovery of improper payments.
• Inspector General reports must include the dollar amount of improper payments recovered by the agency during the report year.
• Most health-program reporting provisions take effect 180 days after enactment, with a one-year state-legislative safe harbor where state law changes are required.
• The bill focuses on fraud and improper-payment prevention and increases federal audit and reporting authority, without creating a new federal grant program.