State Medicaid fraud units would audit high-risk providers each year

State fraud control units would audit a sample of high-risk Medicaid providers and suppliers each year. The sample covers providers and suppliers in a state's Medicaid plan or waiver who are designated high-risk or identified as high-risk by the state unit. Risk factors may include unusual billing, payment problems, or ownership concerns. Audits would be done with the federal health department's Inspector General and, as appropriate, the state agency that runs the Medicaid plan. If the Secretary finds a unit missed the audit requirement, the Secretary may still certify or recertify it if the unit submits and carries out a corrective plan that meets the Secretary's standards. Audits would begin no later than one year after enactment and happen at least once each year after that. Starting with the first annual report submitted after the one-year mark, units would summarize the audits and related overpayments.