To amend title XI of the Social Security Act to establish a pilot program for testing the use of a predictive risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program.
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Committee
Latest Action · January 18, 2024
Read twice and referred to the Committee on Finance.
This bill establishes a two-year pilot program to test a fraud prevention system for Medicare that uses predictive algorithms to flag suspicious claims for durable medical equipment and laboratory tests. The algorithm would score transactions on a scale of 1 to 99, with higher scores indicating greater fraud risk, considering factors like unusual billing patterns, new provider relationships, and ownership changes. The program would only apply to Medicare beneficiaries who have opted in to receive electronic notices, and they can withdraw from the program at any time. When the algorithm flags a high-risk transaction, Medicare would contact the beneficiary by email or phone to allow them to confirm the claim or correct any inaccurate information, and any account suspensions would require human review before taking effect. The pilot program must begin by January 1, 2025, and the bill requires the algorithm to undergo thorough testing and follow White House guidance on artificial intelligence before implementation, with clear notification methods for affected beneficiaries and providers.
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