Quarterly Death-File Checks for Medicaid Providers

Full Title:
Medicare and Medicaid Fraud Prevention Act

Summary#

This bill would require state Medicaid programs to check whether a provider or supplier is deceased when they enroll or revalidate that provider. States must also run that check at least once every three months while the provider stays enrolled. The check must use the Social Security Administration’s Death Master File (a federal list of reported deaths).

  • Main change: Adds a legal requirement for states to check the Death Master File at enrollment, reenrollment, and quarterly thereafter.
  • Who must act: State Medicaid agencies that handle provider enrollment.
  • When it starts: The bill sets a start date of January 1, 2027.
  • Scope wording: The bill text amends Medicaid law. The bill title mentions Medicare, but the change in the text applies to Medicaid.

What it means for you#

  • State Medicaid agencies / governments: Must add a step to their provider enrollment and revalidation processes to check the Death Master File. They must repeat that check at least quarterly for enrolled providers.
  • Medicaid providers and suppliers: Providers enrolling or revalidating with Medicaid may be checked against the Death Master File. If a provider appears on that list, the state would presumably need to act (the bill does not specify the exact steps).
  • Program integrity staff: Will likely need to handle matches, investigate possible false matches, and take follow-up actions.
  • Taxpayers / beneficiaries: This could reduce payments that improperly go to deceased people, which may protect program funds used for care. The bill does not say how savings would be measured or used.
  • Medicare providers or Medicare program: The bill’s text does not change Medicare enrollment rules. It is unclear whether or how the bill’s title (which mentions Medicare) is meant to affect Medicare.

Expenses#

No publicly available information.

  • The bill text and supplied summary do not include a fiscal note or cost estimate.
  • Likely costs that states may face include IT work to add automated checks, staff time to review matches, and ongoing operating costs to run quarterly checks.
  • There may be potential savings from preventing improper payments to deceased individuals, but the bill does not quantify any savings or require reporting of them.
  • It is not specified whether the federal government will fund state implementation or provide technical help.

Proponents' View#

  • The bill appears intended to reduce fraud and improper payments by making sure Medicaid does not pay providers who are dead.
  • Supporters may argue this is a straightforward check using an existing federal database (the Death Master File).
  • It could strengthen program integrity by making provider enrollment and maintenance more accurate on an ongoing basis.
  • The quarterly requirement aims to catch changes quickly rather than relying on infrequent revalidations.

Opponents' View#

  • One concern is that the bill does not explain what states must do after a match. It is unclear how to handle mistaken matches or disputed records.
  • Another concern is the added administrative and IT costs for state Medicaid programs. The bill does not provide funding or a cost estimate.
  • The Death Master File is not perfect. A possible issue is false positives (incorrect matches) or delays in recording deaths, which could disrupt legitimate providers’ payments or enrollment.
  • The bill’s title mentions Medicare, but the text only amends Medicaid law. It is unclear whether the title is intended to signal a broader change or is just a naming choice.