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This bill establishes a 2-year pilot program requiring the Secretary of Health and Human Services to test a predictive risk-scoring algorithm to identify potentially fraudulent Medicare claims for durable medical equipment and clinical diagnostic laboratory tests. The algorithm would score transactions on a scale of 1–99 based on factors such as lack of prior provider-beneficiary relationships, unusual billing patterns, and ownership changes. High-risk transactions would be reviewed and suspended pending beneficiary confirmation, with beneficiaries receiving electronic alerts and opportunities to dispute scores based on inaccurate data. The program would apply only to beneficiaries who have opted into electronic Medicare Summary Notices and would require industry collaboration and testing aligned with federal AI transparency standards.
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