This bill amends the Social Security Act to add a specific screening requirement to state Medicaid provider enrollment rules: states must check federal death records for providers as part of enrollment or revalidation and on a recurring basis. The goal is to reduce improper payments and fraud involving payments to deceased individuals who remain listed as enrolled providers.
The change narrows the gap program-integrity teams have identified — payments that continue because provider rosters include deceased individuals — but it also creates operational work for state agencies, enrollment vendors, and enrolled providers. The statute is narrowly targeted to title XIX enrollment processes rather than broader Medicare enrollment or payment rules.
At a Glance
What It Does
The bill adds a new requirement to states’ Medicaid provider screening: during enrollment or revalidation, and at least quarterly while a provider remains enrolled, the state must check the Death Master File to determine whether the provider or supplier is deceased. The text inserts a new subparagraph to the existing provider-screening provision to accommodate this additional check.
Who It Affects
State Medicaid agencies and their enrollment and program-integrity contractors must build or adapt processes to perform these checks and act on matches. All providers and suppliers enrolled in Medicaid — including sole proprietors, group practices, and organizations that list individuals — face heightened screening and potential follow-up. Enrollment vendors, fiscal agents, and managed care plans that manage rosters will also be pulled into implementation.
Why It Matters
Using the Death Master File creates a simple, repeatable data check that can catch a class of improper payments quickly; setting a quarterly minimum establishes a national baseline for Medicaid programs. But the requirement places costs and operational decisions on states and downstream actors: how to match records reliably, how to handle false positives, and what administrative steps follow a confirmed match.
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What This Bill Actually Does
The bill amends section 1902(kk)(1) of the Social Security Act by splitting the existing single-line requirement into a short structured rule and then appending a new, discrete obligation. Concretely, the statute will require states, as part of a provider’s initial enrollment or later revalidation, to query the federally maintained Death Master File to check whether the enrolling provider or supplier is deceased.
It then requires states to run that same check at least once every quarter while the provider remains enrolled.
The provision identifies the Death Master File by its statutory definition (referring to the Bipartisan Budget Act of 2013) rather than describing the dataset in the bill text. The change is limited to Medicaid (title XIX) enrollment and does not alter Medicare enrollment statutes or Medicare program rules within the text of this bill.
The statutory amendment rearranges the existing language to allow multiple subparagraphs under the same screening clause and appends the new subparagraph for the death-record check.Operationally, the bill creates a recurring data-integration task for states: map provider records to the DMF fields, schedule quarterly matches, and reconcile hits. The text is silent on downstream legal or administrative consequences of a confirmed death-match — it does not prescribe automatic termination, suspension, recovery procedures, or appeal rights — leaving those actions to state policy and existing Medicaid rules.
The bill also does not appropriate federal funds for implementation, so states will likely absorb IT and staffing costs or seek existing federal grant funds or reallocate budgets.A notable drafting wrinkle: the short title references Medicare and Medicaid, but the statutory amendment applies only to Medicaid enrollment rules. That mismatch will matter to stakeholders who read the title expecting parallel Medicare changes.
The bill’s focus on a single, specific data check keeps its scope narrow: it standardizes a data-driven screen rather than overhauling provider-screening frameworks or adding new criminal penalties.
The Five Things You Need to Know
The bill inserts a new subparagraph (B) into section 1902(kk)(1) of the Social Security Act to establish the death-record check as an explicit component of Medicaid provider screening.
It requires states to check the 'Death Master File' as that term is defined in section 203(d) of the Bipartisan Budget Act of 2013, rather than creating a new federal dataset.
States must run the DMF check at the time of enrollment or revalidation and then not less frequently than quarterly for each enrolled provider or supplier.
The statutory text becomes effective for checks beginning January 1, 2027; the bill does not include implementation funding or a federal enforcement mechanism tied to the new check.
The bill does not specify what state actions must follow a confirmed DMF match (for example, immediate termination, temporary suspension, or an appeals process), leaving those details to state policy.
Section-by-Section Breakdown
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Short title — 'Medicare and Medicaid Fraud Prevention Act'
This section provides the act’s short title. Practically, stakeholders should note the title references both Medicare and Medicaid even though the operative amendment in Section 2 targets only Medicaid provider screening. That mismatch can cause stakeholder confusion and suggests either an intent to expand later or drafting imprecision.
Amendment to Medicaid provider-screening statute (42 U.S.C. 1396a(kk)(1))
This is the operative change. The bill modifies the existing single sentence that governs state provider screening by (1) converting the opening to an '(A) IN GENERAL' heading, and (2) adding a new '(B) ADDITIONAL PROVIDER SCREENING' requiring states to check the Death Master File during enrollment/revalidation and at least quarterly thereafter. The insertion formalizes a recurring data-check obligation and creates a discrete legal duty for states within the title XIX provider-enrollment framework.
Scope limited to title XIX enrollments; effective date provided
The amendment explicitly applies to enrollment and revalidation under title XIX (Medicaid) and sets the mechanism for ongoing quarterly checks. The bill text includes a specific start date (January 1, 2027) for when those checks must begin. The provision does not amend other provider-screening rules, funding sections, or Medicare statutes, so its legal reach is confined to state Medicaid enrollment systems.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- State Medicaid program-integrity units — gain a standardized, periodic data source to identify deceased individuals on provider rosters, which can reduce improper payments and support audits.
- Federal and state taxpayers — stand to benefit from reduced improper Medicaid payments if the DMF checks lead to removal of deceased providers and recovery of erroneous payments.
- Medicaid beneficiaries and care coordinators — may see fewer administrative or billing anomalies caused by deceased providers remaining in provider directories, improving care continuity and claims accuracy.
Who Bears the Cost
- State Medicaid agencies — must develop or expand technical integrations, data-matching processes, staffing for reconciliation, and possibly appeals procedures without dedicated implementation funding in the bill.
- Enrollment vendors and fiscal agents — will need to update software and workflows to perform quarterly DMF queries and manage match resolution, incurring development and maintenance costs.
- Small and solo providers — face the risk of being temporarily or incorrectly flagged by automated matches, requiring additional paperwork or time to resolve identity or record errors; they may also bear compliance burdens if states impose new documentation checks.
Key Issues
The Core Tension
The central dilemma is between strengthening program integrity with a low-friction, regular data check and the practical and legal costs of doing so: the check can reduce improper payments, but relying on an imperfect federal death dataset shifts matching, verification, and consequential enforcement burdens to states and providers without prescribing how to manage errors or funding implementation.
The bill relies on the Death Master File as the authoritative data source, but the DMF has known limitations: incomplete reporting, time lags, and variations in available identifiers. Those data-quality problems create two implementation risks.
First, false positives (e.g., name collisions, SSN transcription errors) could lead to active providers being flagged as deceased and removed or suspended without clear statutory protections. Second, false negatives mean the check will not catch all improper payments, giving a false sense of completeness if states treat the DMF check as a comprehensive remedy.
Another tension is cost and authority. The bill mandates a new recurring operational duty but provides no funding or prescriptive remedies after a match.
States must decide whether a DMF hit triggers immediate termination, a temporary suspension pending verification, or a notification-and-repair process — and those choices affect due-process protections for providers and the risk of disrupting patient care. Finally, the bill’s title references Medicare, yet the text amends only Medicaid law; that discrepancy raises questions about legislative intent and could complicate stakeholder expectations about parallel Medicare reforms.
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