Jul. 10, 2023

HARRISBURG – Legislation sponsored by Rep. Mike Cabell (R-Luzerne) to help prevent fraud within the Medicaid program has been approved by the House Human Services Committee.

House Bill 876 would require any Medicaid provider to use a National Provider Identifier (NPI) when submitting claims for reimbursement. The NPI is a unique identification number for covered health care providers mandated by federal law. If the provider does not have an NPI, they would be required to register for a State Provider Identifier (SPI) with the Pennsylvania Department of Human Services.

“Several years ago, the Office of Attorney General released the findings of a grand jury investigation of fraud within the Medicaid program and this proposal was one of the recommendations,” said Cabell. “My legislation would simply create another layer of protection to ensure proper reimbursement is being rendered for the services that are being provided. It seems like a no-brainer to me.”

Under the bill, the department would establish a standardized program for any company which lacks an NPI and must register for provider identification with the state. The training would teach providers how to submit claims for reimbursement from Medicaid by using their provider number along with the date, time and service provided.

The legislation also includes another attorney general recommendation which would clarify current law on where civil claims for Medicaid fraud can be filed.

Cabell’s bill now moves to the full House of Representatives for consideration.

Representative Mike Cabell
117th Legislative District
Pennsylvania House of Representatives

Media Contact: Andy Briggs
RepCabell.com / Facebook.com/RepMikeCabell