Medicare Transaction Fraud Prevention Act

Sponsor: David Schweikert (Republican-AZ)June 12, 2025

AI-generated ?

Report an error

Introduced

In Committee

Passed One Chamber

Passed Both Chambers

Signed into Law

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.

Medicare would test AI to spot fraud in medical equipment and lab test payments.

This bill would create a two-year pilot program to use special computer programs, called predictive risk-scoring algorithms, to help find potential fraud in Medicare payments. It would focus on claims for durable medical equipment and lab tests. Only Medicare beneficiaries who choose to join the program would be affected.

What Would Change

Today, Medicare oversees payments for durable medical equipment and lab tests without a specific pilot program using predictive computer algorithms. If this bill becomes law, a two-year pilot program would begin by January 1, 2026. This program would use special computer programs to score Medicare claims for risk, focusing on beneficiaries who choose to participate, and could lead to reviews and alerts for high-risk transactions.

Key Provisions

Creates a two-year pilot program, starting by January 1, 2026, to test using computer programs to oversee Medicare payments for medical equipment and lab tests.
Lets Medicare beneficiaries choose to join the pilot program and leave it at any time.
Requires the government to use a computer program that scores Medicare claims from 1 (lowest risk) to 99 (highest risk).
Requires thorough testing and review of the computer program before it is put into use.
Gives beneficiaries a chance to confirm or correct high-risk transactions identified by the program.
Requires electronic alerts and notices to beneficiaries if a high-risk transaction is paused.

View on Congress.gov

HR 3996 · 119th Congress · June 12, 2025 · AI Summary by gemini-2.5-flash · 9/10

Medicare Transaction Fraud Prevention Act

What Would Change

Key Provisions

Lobbying Activity