Bill > S2066

This bill establishes a two-year pilot program through the Medicare program to test a predictive risk-scoring algorithm for overseeing payments related to durable medical equipment (DME) and clinical diagnostic laboratory tests. The pilot program will be voluntary for Medicare beneficiaries who opt in to receive electronic Medicare Summary Notices and participate in the program. The algorithm will score transactions on a scale from 1 (least risky) to 99 (most risky), considering factors such as new provider-patient relationships, unusual billing patterns, electronic fund transfer changes, and ownership shifts. Before implementation, the algorithm must undergo rigorous testing and review, with transparency about how beneficiary data is collected and processed. If a transaction is flagged as high-risk, the system will suspend the transaction and notify the beneficiary electronically, giving them an opportunity to confirm or challenge the transaction. The Secretary of Health and Human Services will collaborate with industry representatives during development and maintain the authority to terminate Medicare cards if fraud is suspected. Importantly, any transaction suspension will require human review informed by the algorithm, ensuring that artificial intelligence supports but does not solely determine fraud prevention efforts.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/2066/all-info