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SB 1373

An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in fraud and abuse control, further providing for definitions and for restrictions on provider charges and payments and providing for claim submissions.

2025-2026 Regular Session Introduced by Lisa Baker and 6 co-sponsors

SB 1373 tightens fraud controls in PA human services by clarifying definitions, restricting provider charges and payments, and reforming claim submissions to curb improper payments

Re-referred to Appropriations
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WeVote Research Nonpartisan
Bill Summary · SB 1373

Overview

SB 1373 (2025-2026, Pennsylvania) amends the Human Services Code (act of June 13, 1967, P.L.31, No.21) to tighten fraud and abuse controls, clarify definitions, restrict certain provider charges and payments, and address claim submissions. The bill has been referred to the Health & Human Services committee, with multiple Senate sponsors, and has progressed to report as committed after first consideration.

Purpose and intent

  • Strengthen enforcement against fraud and abuse in Pennsylvania’s human services programs.
  • Provide clearer definitions related to fraud, abuse, provider charges, and payment restrictions to reduce improper or excessive costs.
  • Reform how claim submissions are handled to improve accuracy, transparency, and recoveries of improper payments.

Key provisions and changes

While the full text is not provided here, the bill’s description indicates the following focus areas:

  • Definitions: Revisions or additions to terms used in fraud and abuse investigations to ensure consistent interpretation across programmatic administrations.
  • Restrictions on provider charges: New or tightened limits on what providers may charge or how charges are calculated under human services programs.
  • Restrictions on payments: Rules governing when and how payments may be made to providers, potentially including caps, offsets, or disallowances for improper claims.
  • Claim submissions: Revisions to the process for submitting claims, likely aiming to improve accuracy, documentation standards, and auditability, and to facilitate enforcement actions for incorrect or fraudulent submissions.

These elements are intended to reduce waste, fraud, and abuse, ensure program dollars are used appropriately, and streamline enforcement and recovery efforts.

Who is affected

  • Health and human services providers participating in Pennsylvania’s human services programs (e.g., Medicaid and related social services programs) would be directly impacted by payment and charge restrictions.
  • State agencies responsible for administering these programs (e.g., departments within Pennsylvania’s health and human services administrations) would implement and enforce the new definitions, restrictions, and claims processes.
  • Individuals interfacing with the system (providers and recipients) could experience changes in billing practices, claim submission timelines, and potential recoupment actions.

Procedural and timeline aspects

  • Legislative action: Referred to the Health & Human Services committee (April 2026), with a subsequent first consideration and passage to “reported as committed” (June 9, 2026), indicating advancement in the legislative process.
  • If enacted, the provisions would become effective per the bill’s effective date provisions, which typically appear in the final enacted text and may include phased or delayed implementation to allow agencies to adjust systems and practices.

Potential impacts and considerations

  • Administrative burden: Providers and state agencies may face new documentation and compliance requirements for charges, payments, and claims submissions.
  • Compliance costs: Businesses and organizations participating in state-funded programs may incur costs to align with revised definitions and procedures.
  • Fraud prevention and recoveries: Enhanced ability to identify and recoup improper payments, potentially reducing waste and improving program integrity.
  • Transitional considerations: Implementing new claim submission processes may require updates to billing software and staff training.

If you’d like, I can tailor this summary to a specific audience (e.g., health care providers, policy analysts) or pull in the exact statutory language and fiscal notes once the full text becomes available.

Compiled from official sources — confirm details with the bill’s official record.

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