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Legislative Year: 2024 Change

Bill Detail: HB24-1146

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Title Medicaid Provider Suspension for Organized Fraud
Status Governor Signed (02/20/2024)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors S. Bird (D)
R. Taggart (R)
Senate Sponsors R. Zenzinger (D)
J. Bridges (D)
House Committee Appropriations
Senate Committee Appropriations
Date Introduced 01/29/2024

Joint Budget Committee. The bill authorizes the department of
health care policy and financing (state department) to suspend the
enrollment of a medicaid and children's basic health plan (programs)
provider only if the state department identifies that the provider is
participating in an alleged and ongoing organized crime or organized
fraud scheme (scheme) that impacts the programs and if the state
department documents in writing that at least 3 of the following factors
are met:
  • The provider has been enrolled in the programs for less
than 3 years;
  • At least 3 providers are involved in the scheme;
  • The collective billing amount identified in the scheme
exceeds $1 million;
  • The provider's billing indicates a pattern of abuse or
  • The volume of claims or billing amount has increased at a
significant rate and there is no other reasonable explanation
for the increase;
  • The federal centers for medicare and medicaid services has
approved a provider enrollment moratorium for the
provider type involved in the scheme; or
  • The state department has notified law enforcement of the
The state department is required to notify the provider of the
suspension in writing, including the reasons for the suspension.
The state department may suspend a provider's enrollment for an
initial period of 6 months while the state department conducts a review
of the scheme. After the state department's review is complete, the state
department must reinstate the provider's enrollment if the department
determines the provider did not engage in a scheme. If the state
department's review cannot be completed during the initial 6-month
period, the state department may extend the review period in additional
6-month increments if the state department documents in writing the
necessity for extending the review.

Committee Reports
with Amendments
Full Text
Full Text of Bill (pdf) (most recent)
Fiscal Notes Fiscal Notes (01/30/2024) (most recent)  
Additional Bill Documents Bill Documents
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  • Past fiscal notes
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  • Bill History
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