Medicare Transaction Fraud Prevention Act

The Medicare Transaction Fraud Prevention Act establishes a two-year pilot program (starting January 1, 2026) to test predictive risk-scoring algorithms that identify potentially fraudulent claims for durable medical equipment and clinical lab tests under Medicare. It applies only to Medicare beneficiaries who voluntarily opt in to electronic Medicare Summary Notices and participate in the pilot. The program would score transactions (1-99 risk level) using factors like billing patterns or provider ownership changes, triggering human reviews for high-risk cases before suspending payments. Beneficiaries would receive notifications and opportunities to correct errors, with safeguards requiring algorithm testing per federal guidelines and prohibiting automatic suspensions without human oversight.