New Bill Could Protect Payments to Providers Accused of Medicaid Fraud


A new bill introduced in Congress would help healthcare providers continue to receive Medicaid payments while fraud allegations are investigated.

US Capitol

Congress introduced a new bill that would help healthcare practices accused of fraud possibly keep receiving Medicaid payments while their cases are reviewed.

Through the Medicaid Program Integrity Enhancement Act of 2016, lawmakers was to establish criteria so the US Department of Health & Human Services can’t freeze Medicaid payments to providers simply because the provider is accused of fraud.

Although the bill would pertain to providers in all areas, this could significantly impact dentists.

According to the group Texas Dentists for Medicaid Reform, the legislation would have benefitted several Texas orthodontists who were accused of dental Medicaid fraud for dental and orthodontic treatment of children in 2011.

Some even went bankrupt from lack of payment while awaiting resolutions for their cases.

According to its sponsors, the Medicaid Due Process Integrity Act would:

1. Prevent unnecessary payment suspensions by requiring a Medicaid agency to consult with a state attorney general on the credibility of allegations prior to suspending payments.

2. Protect beneficiary access to care by requiring a state to consider the impact a payment suspension may have on beneficiary access to care, prior to withholding payments.

3. Guarantee due process of law by requiring states to cease payment suspensions where an investigation has ended after 18 months.

4. Require states to create an appeal process for providers to challenge charges against them.

However, as the law was just introduced, it is not yet known whether or when the bill could become law.

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