Governor signs Caldier bill establishing fair and predictable Medicaid audit process

Legislation directing the Washington State Health Care Authority to establish a fair and predictable Medicaid audit process was signed into law Monday by Gov. Jay Inslee. House Bill 1314, sponsored by Rep. Michelle Caldier, R-Port Orchard, requires the Authority to meet specific standards related to auditing timelines, the recovery of payments, the use of statistical sampling and the submission of records. It also establishes standards for contractors performing audits on behalf of the Authority.

All health care providers in Washington state that accept Medicaid are subject to audit. Aggressive auditing practices have been a contributing factor in the decision by many providers to no longer accept Medicaid enrollees, which has made it more difficult for enrollees to find a local provider.

In a floor speech on House Bill 1314, Caldier detailed one case in which a dentist received a bill for $946,000 after the Authority uncovered a $10,000 billing error. As a former dentist who ran her own private practice, she says audits are necessary, but believes that’s a clear example of government gone wild.

“People should have confidence state agencies will treat them fairly and provide quality customer service,” said Caldier. “I worked hard with the Authority to address the concerns of those in the medical community and reform the way Medicaid audits are conducted going forward. The result of that collaboration is a bill that will protect the integrity of the auditing process and better serve the network of providers in Washington state, while also increasing access to care for our most vulnerable citizens.”

House Bill 1314 was unanimously approved in the House and Senate before being signed into law by the governor. It will go into effect later this year.


Washington State House Republican Communications