WASHINGTON – U.S. SenatorBill Cassidy, M.D. (R-LA) and Mike Braun (R-IN) introduced the Medicare Transaction Fraud Prevention Act 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. U.S. Representative Schweikert (R-AZ-01) introduced the companion legislation in the U.S. House of Representatives.
“Medicare fraud should always be fought, but with insolvency only eight years away we must be particularly careful about how we spend every dollar,” said Dr. Cassidy. “This gives CMS the tools they need to fight fraud and to save the money to actually take care of patients.”
“An annual loss of $60 billion is unacceptable. It’s time for CMS to strengthen their fraud detection process in order to stop the hemorrhaging of the Medicare trust fund,” said Senator Braun.
“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 better identify and stop fraud when it takes place. By embracing innovative health care 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 Representative Schweikert.
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 (DME) products in order to obtain Medicare reimbursements.
The Medicare Transaction Fraud Prevention Act would direct 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 of dollars without overhauling their system. It does not authorize any funding, and beneficiaries can opt out at any time.
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