Senate Resolution 216 Printer's Number 1416

PENNSYLVANIA, January 30 - millions of dollars if the State would have required managed

care organizations to meet a minimum Medical Loss Ratio Standard

and required remittances if the standard was not met; and

WHEREAS, The United States Office of Inspector General

published an audit report in 2024 that found that Pennsylvania

improperly claimed $551 million in Medicaid funds for its

school-based program; and

WHEREAS, Investigators have identified a large amount of

Medicaid fraud in Minnesota and many individuals have been

charged for fraud in Minnesota, demonstrating that State

Medicaid programs could be vulnerable to exploitation; and

WHEREAS, Based on the audit published in 2017, the audit

published in 2024 and the events that are unfolding nationally,

Pennsylvania should perform an audit to ensure that our medical

assistance programs are operating efficiently and safe from

fraud; and

WHEREAS, Ensuring the efficiency and security of our State's

medical assistance programs will ensure that our medical

assistance program can be funded and vulnerable populations

continue to receive coverage without interruption; therefore be

it

RESOLVED, That the Senate direct the Legislative Budget and

Finance Committee to conduct an audit and issue a report on the

State's medical assistance programs; and be it further

RESOLVED, That the Legislative Budget and Finance Committee

be authorized to request from Commonwealth agencies and

departments any data or information that is necessary to conduct

the study; and be it further

RESOLVED, That the report include all of the following:

(1) The actuarial standards used in Pennsylvania to

20260SR0216PN1416 - 2 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30