Senators Schmitt, Hassan, Sheehy Introduce Bipartisan Bill to Cut Down on Medicare Waste, Fraud, Abuse

WASHINGTON – U.S. Senators Eric Schmitt (R-MO), Maggie Hassan (D-NH), and Tim Sheehy (R-MT) introduced the Medicare Transaction Fraud Prevention Act which will use artificial intelligence (AI) to cut down on the waste, fraud, and abuse in the Medicare system.

“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.

“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 waste, fraud, and abuse in the system while also providing appropriate privacy protections, human review, and protection of the benefits that seniors have paid into and deserve.”

“The best thing we can do to protect the critical resources Americans rely on, and shore up programs like Medicare, is root out fraud, waste, and abuse. We must strengthen Medicare for the people that really need it, and that’s exactly what this bill does by combatting Medicare transaction fraud to better protect Americans’ hard-earned money and ensure every taxpayer gets a better return on their investment,” said Senator Sheehy.

Background

• The bill would create a pilot program for testing the use of a predictive risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program.
• The AI algorithm would assign a risk score to all FFS transactions and sends to the Inspector General’s office.
  • High risk scores are for 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.

Click HERE to Read the full text of the bill.

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