WASHINGTON, D.C. (AVC News) — U.S. Rep. Troy Balderson, R-Ohio, has introduced legislation aimed at giving states additional tools to identify and prevent fraud, waste and abuse in the Medicaid program.
Balderson, who represents Ohio’s 12th Congressional District, introduced the Strengthening Medicaid Analytics to Reduce Theft, or SMART, Act.
Medicaid is administered jointly by the federal government and states. Under the proposed legislation, the U.S. Department of Health and Human Services would be required to make standardized data-analytics technology available to every state.
The technology would be designed to work alongside existing state systems, including Medicaid Management Information Systems, eligibility and enrollment systems and other program-integrity tools.
According to Balderson’s office, states would be able to use the technology to identify potentially improper billing, utilization and enrollment patterns; receive fraud, waste and abuse alerts; access federal dashboards and investigative tools; and conduct state-specific analyses.
The legislation also would require HHS to develop risk indicators for providers, suppliers and other entities operating across multiple states or participating in multiple federal health care programs.
The system could analyze billing, utilization, enrollment and other federal data to identify patterns that may not be apparent when individual states review their own Medicaid data.
“The SMART Act gives states the tools they need to root out fraud, waste, and abuse and hold those exploiting Medicaid accountable,” Balderson said. “Medicaid is an important lifeline for millions of Americans, and we have a responsibility to make sure every dollar reaches the people who need it most.”
Scott Partika, director of the Ohio Department of Medicaid, said Ohio already uses data analytics to identify unusual billing patterns, high-risk providers and potential improper payments.
“These tools enable us to move quickly, prioritize potential fraud, waste, and abuse, and ensure Medicaid dollars are used appropriately for the people who depend on this program,” Partika said.
The bill would also require HHS to provide technical assistance to states implementing the technology and submit an annual report to Congress on its implementation and effectiveness.
Balderson’s legislation is one of 14 bills introduced by Republicans on the House Energy and Commerce Committee addressing fraud in federally funded health care programs.
Committee Chairman Brett Guthrie, R-Ky., said the package is intended to strengthen efforts to identify fraud and improper payments in federal health programs.
The SMART Act has been introduced in the House and would need to advance through Congress before becoming law.
Last Updated on October 5, 2026 by AVC News
