This bill establishes a two-year pilot program beginning January 2026 that uses artificial intelligence algorithms to detect and prevent fraud in Medicare payments for durable medical equipment and clinical diagnostic laboratory tests. The program will assign risk scores to transactions, with human reviewers making final decisions about whether to suspend suspicious claims and giving beneficiaries a chance to respond and confirm transactions before payment is denied. Participation is voluntary and limited to Medicare beneficiaries who have opted into electronic notices and the pilot program itself. The bill requires the Secretary of Health and Human Services to test the algorithm thoroughly, work with industry suppliers on development, and notify beneficiaries and providers about how their data is used, while also requiring coordination with the Office of the Inspector General. No specific funding amount is mentioned in the legislation, but the two-year timeline gives the government time to evaluate whether this fraud-prevention approach works effectively before potentially expanding it.
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