Requiring protections for whistleblowers under Medicaid

Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended— (1) in subsection (a)— (A) in paragraph (89), by striking and at the end; (B) in paragraph (90), by striking the period at the end and inserting; and; and (C) by inserting after paragraph (90) the following new paragraph: (91) provide that, beginning January 1, 2028, the State shall comply with the whistleblower protection requirements under subsection (zz).; and (2) by adding at the end the following new subsection: (zz) Whistleblower protection requirements (1) In general For purposes of subsection (a)(91), the whistleblower protection requirements under this subsection are that the State shall provide assurances satisfactory to the Secretary that such State has in effect laws that— (A) prohibit adverse employment actions that are taken against a covered individual because such individual made a protected disclosure; and (B) establish procedures under which an individual who alleges that such an action was taken against such individual may seek relief, which shall include any applicable remedies described in paragraph (2), through an administrative process and, in the case that such individual disagrees with the outcome of such administrative process, through judicial review. (2) Remedies described For purposes of paragraph (1), the remedies described in this paragraph are the following: (A) Reinstatement of employment at the seniority status that the covered individual would have if the adverse employment action described in paragraph (1)(A) that was taken with respect to such individual had not occurred. (B) 2 times back pay, including interest at a rate to be determined by the Secretary. (C) Compensation for special damages sustained as a result of such adverse employment action, including litigation costs and reasonable attorneys’ fees. (D) In the case that such adverse employment action was taken with malice or reckless indifference to the rights of such covered individual under this subsection, punitive damages. (3) Definitions In this subsection— (A) Adverse employment action The term adverse employment action means, with respect to the terms and conditions of employment of an individual, a discharge, demotion, suspension, threat, incidence of harassment, or other act of discrimination directed at such individual. (B) Covered entity The term covered entity means— (i) a supervisor; (ii) a State Medicaid agency; (iii) a State or Federal law enforcement agency; (iv) the Department of Health and Human Services; (v) the Office of the Inspector General of the Department of Health and Human Services; (vi) Congress; or (vii) any other entity designated by the Secretary. (C) Covered individual The term covered individual means an individual who is engaged in the administration, management, oversight, or delivery of items or services under a State plan (or waiver of such plan) and is an employee, contractor, subcontractor, or agent of such State or a political subdivision of such State. (D) Protected disclosure The term protected disclosure means a disclosure of information by a covered individual to a covered entity that such individual reasonably believes evidences, with respect to a State Medicaid program— (i) a violation of an applicable law, rule, or regulation; (ii) fraud, waste, or abuse involving Federal or State funds; (iii) gross mismanagement; (iv) an abuse of authority; or (v) a substantial and specific danger to public health or safety..