The STOP FRAUD in Medicaid Act directs state Medicaid fraud control units to investigate and prosecute fraud committed by beneficiaries—people applying for or receiving Medicaid benefits—in addition to their current focus on provider fraud. Currently, these state units primarily investigate healthcare providers who commit fraud; this bill expands their mandate to include individuals who misrepresent information to obtain or keep Medicaid coverage. The bill makes technical amendments to the Social Security Act to clarify that state fraud units must address "application for, or receipt of" benefits alongside the provision of services. The legislation becomes effective 180 days after it is signed into law, giving states time to adjust their fraud control operations to include beneficiary fraud investigations alongside their existing provider-focused work.
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