Medicare Fraud Prevention: New Pilot Program with Risk Algorithm
This act establishes a two-year pilot program to detect fraud in Medicare, specifically for durable medical equipment and laboratory tests. It will use a risk-scoring algorithm, and participation will be voluntary for Medicare beneficiaries who opt-in to electronic notifications.
Key points
Introduction of an algorithm to assess fraud risk in Medicare payments for medical equipment and laboratory tests.
The pilot program will run for two years, starting no later than January 1, 2026.
Participation in the program is voluntary for Medicare beneficiaries who agree to electronic notifications.
If a high risk is detected, a transaction may be suspended pending beneficiary confirmation.
Status:
Introduced
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