August Pfluger Seeks to Put Stakes on the Hook for Medicaid Oversight

Representative August Pfluger (R) introduced legislation this week that would require every state Medicaid program to designate an official responsible for overseeing key financial and program-integrity duties.

The Medicaid Integrity and Fiscal Responsibility Act would require the designated official to ensure states have policies, monitoring systems, and corrective actions in place for Medicaid financial operations.

Responsibilities would include accurate, timely claims processing; preventing fraud, waste, and improper payments; accurately reporting expenditures to the Department of Health and Human Services; and maintaining internal financial controls.

"Every dollar lost to fraud, waste, and improper payments is a dollar taken from patients who depend on Medicaid and from the taxpayers who fund it," said Pfluger. "My legislation puts a single, accountable official in charge of Medicaid claims processing, payment integrity, financial reporting, and internal controls in each state."

The legislation was included in a House Energy and Commerce Committee package of 14 bills focused on combating fraud and improper payments across federally funded health programs. The committee said the broader package is intended to strengthen data collection, anti-fraud enforcement, and state accountability.

The committee said responsibility for Medicaid financial integrity can currently be dispersed among multiple state agencies or offices. Pfluger's legislation would establish a clearly designated official responsible for the listed fiscal duties.

The legislation comes as the Energy and Commerce Committee continues its oversight of state Medicaid programs, including a June hearing examining fraud risks and weaknesses in state-level oversight.