WASHINGTON – U.S. Senators Maggie Hassan (D-NH), Eric Schmitt (R-MO), and Tim Sheehy (R-MT) introduced the Medicare Transaction Fraud Prevention Act which will use predictive modeling to cut down on the waste, fraud, and abuse in the Medicare system while also protecting people’s privacy and access to care.
“New technologies allow for innovative ways to root out waste, fraud, and abuse and safeguard taxpayer dollars,” said Senator Hassan. “This bipartisan bill takes a common-sense approach to protecting seniors and Medicare as a whole by identifying possible fraudulent activity while also providing appropriate privacy protections, human review, and protection of the benefits that seniors have paid into and deserve.”
“Artificial intelligence has set our nation at the precipice of the next great American revolution, and harnessing AI’s power to identify potential waste, fraud, and abuse will help strengthen the Medicare system for those who depend on it and ensure our taxpayer dollars are being well spent. I’m glad to lead this bipartisan bill to utilize cutting edge technology to help America’s seniors and protect Medicare benefits,” said Senator Schmitt.
The Medicare Transaction Fraud Prevention Act would create a pilot program for testing a risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program. The predictive algorithm would assign a risk score to transactions, which would then be sent for review to the Inspector General’s office. High risk scores would be assigned to claims billed at a rate or style deemed irregular. This would allow human inspectors to prioritize reviews of transactions most likely to be fraudulent. Medicare beneficiaries can opt-in to the program, so Medicare payment data is only obtained by the pilot with consent.
Senator Hassan is working to cut waste, fraud, and abuse and save taxpayer dollars. In April, in her role as Ranking Member of the Joint Economic Committee, Senator Hassan helped lead a hearing focused on ways to use artificial intelligence and data to improve government efficiency.
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