Medicare Transaction Fraud Prevention Act

This bill establishes a 2-year pilot program (starting January 2025) to test predictive algorithms that assess risk in Medicare payments for durable medical equipment (like wheelchairs) and lab tests. It applies only to Medicare beneficiaries who have opted in to receive electronic Medicare Summary Notices. The program uses algorithms to flag high-risk transactions based on factors like unusual billing patterns or new provider ownership, but requires human review before suspending payments. Beneficiaries can opt out anytime, and the system must notify them about risk scores and provide a 3-month period of electronic notices if a transaction is flagged.