H.R.3996

Medicare Transaction Fraud Prevention Act establishes a pilot program to test predictive risk-scoring algorithms for Medicare payments.

The Medicare Transaction Fraud Prevention Act amends title XI of the Social Security Act to establish a pilot program. This program tests the use of predictive risk-scoring algorithms to oversee payments for durable medical equipment and clinical diagnostic laboratory tests under Medicare. The Secretary of Health and Human Services will adopt an algorithm to score transactions from 1 (least risky) to 99 (most risky). Beneficiaries can opt-in to the program, which involves receiving electronic Medicare Summary Notices and participating in the pilot.