WASHINGTON – U.S. Senators Mike Braun and Senator Dr. Bill Cassidy introduced legislation to create an algorithm-based pilot period of oversight at the Center for Medicare and Medicaid Services (CMS) targeted at the irregular billing activity of certain products for the 5% of beneficiaries that already receive electronic notices. Representative Schweikert introduced the companion legislation in the House of Representatives.
Medicare loses approximately $60 billion annually due to fraud, errors, and abuse involving both predatory healthcare professionals and anonymous organized criminals. These individuals charge Medicare beneficiaries for unapproved diagnostic tests and fraudulently bill them for wheelchairs, braces, and other Durable Medical Equipment products to obtain Medicare reimbursements.
“An annual loss of $60 billion is unacceptable. It’s time for CMS to strengthen their fraud detection process to stop the hemorrhaging of the Medicare trust fund,” said Senator Mike Braun
“Medicare fraud should always be fought, but with insolvency only eight years away we must be particularly careful about how we spend every dollar. This gives CMS the tools they need to fight fraud and to save the money to care for patients,” said Senator Dr. Bill Cassidy.
“Every year, too many Medicare beneficiaries fall victim to scammers who fraudulently charge them for medical supplies to take advantage of their reimbursements. This has led to Medicare losing billions annually and a depleted Medicare trust fund without much accountability for those at fault. The Medicare Transaction Fraud Prevention Act helps protect beneficiaries and taxpayers by analyzing transactions instantly to identify better and stop fraud when it takes place. By embracing innovative healthcare technologies like AI, we can meet our moral obligation to ensure beneficiaries receive the care they deserve and prevent U.S. taxpayer dollars from being stolen by fraudsters,” said Rep. David Schweikert.
The Medicare Transaction Fraud Prevention Act:
- Directs CMS to create a two-year pilot to oversee Medicare-covered purchasing of DME and other diagnostic testing-related products. By asking beneficiaries to verify certain purchases, this bill will give CMS increased access to vital predictive data, test proof of concept for future use, and save hundreds of millions without overhauling their system.
- This bill does not authorize funding, and beneficiaries can opt-out anytime.
Bill text here.
