Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
This bill creates a two-year pilot program, starting no later than January 1, 2026, to test whether artificial intelligence algorithms can help Medicare prevent fraud in payments for durable medical equipment and laboratory tests. The program will voluntarily enroll Medicare beneficiaries who receive electronic billing statements and use a risk-scoring system (rated 1 to 99) to flag potentially suspicious transactions based on factors like unusual billing patterns, new provider relationships, and fund transfer changes. When a transaction receives a high-risk score, Medicare will contact the beneficiary by email or phone to confirm it's legitimate before paying, and beneficiaries can dispute scores they believe are wrong. The Secretary of Health and Human Services must thoroughly test the algorithm, notify affected beneficiaries and providers about how their data is used, and ensure a human reviews flagged transactions before any payment suspension occurs. The program will work with industry partners, including equipment suppliers, to develop and implement the system.
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