Congress expands Medicaid audits, extending lookback to 4 years
H.R. 9422 — Medicaid RAC Improvement Act of 2026 · Filed by Gus Bilirakis (R-FL) · 9 cosponsors · Introduced Jun 24, 2026 · Referred to committee
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What it does
This bill strengthens federal oversight of Medicaid Recovery Audit Contractor (RAC) programs, which are state-run systems that identify and recover overpayments to healthcare providers. It requires states to report annually on their audit activities, mandates that managed care organizations participate in audits, extends the lookback period for audits from current limits to 4 years, and directs the federal government to study barriers preventing states from running RAC programs and test solutions through a demonstration project.
Why we flagged it
The bill's core function is to expand federal oversight, reporting requirements, and audit scope for state Medicaid RAC programs, with particular focus on including managed care organizations in audit activities and extending the retrospective audit period.
What the text implies
- Extended 4-year lookback period for audits may create significant retroactive liability for healthcare providers and managed care organizations, potentially destabilizing provider networks if audit demands are large.
- Mandatory inclusion of managed care organizations in RAC audits shifts audit burden from traditional fee-for-service providers to capitated plans, which may respond by tightening networks or raising premiums.
The full analysis lists 5 implications of this text.
Who stands to gain
Recovery audit contractors (RAC vendors); Healthcare consulting firms specializing in compliance; State Medicaid agencies (administrative funding)