Medicare Transaction Fraud Prevention Act

This bill establishes a two-year pilot program (starting January 2026) to test predictive risk-scoring algorithms for monitoring Medicare payments for durable medical equipment and clinical diagnostic lab tests. It requires voluntary participation from Medicare beneficiaries who opt in to electronic Medicare Summary Notices and agree to the pilot. The algorithm would score transactions from 1 (low risk) to 99 (high risk), triggering human review for high-risk cases, with beneficiaries given a chance to correct errors via email or phone. The program mandates algorithm testing, beneficiary notifications about data use, and requires human oversight before suspending payments or transactions. It specifically covers claims for durable medical equipment and lab tests under Medicare.