State Medicaid units would audit high-risk providers each year

A state Medicaid fraud control unit would audit a statistically valid sample of high-risk providers and suppliers each year. The audits cover providers and suppliers in a state Medicaid plan or waiver who are federally designated as high risk or identified as high risk by the state unit. State risk factors may include unusual billing, past audits, payment or ownership concerns, and credible fraud allegations. If the Secretary finds that a unit missed the audit requirement, the Secretary may still certify or recertify it if the unit submits and follows a corrective action plan that meets the Secretary’s standards. Audits would start no later than one year after enactment and happen at least annually. The first report due after that one-year point would include an audit summary.