Medicare Transaction Fraud Prevention Act

This bill sets up a two-year Medicare pilot to test a computer tool that rates how risky certain claims look, from 1 (low) to 99 (high). It focuses on payments for durable medical equipment (like wheelchairs) and clinical lab tests, aiming to spot fraud or errors before money goes out. Any pause or suspension of a claim must be decided by a person, using the tool’s score as input .

People on Medicare can choose to join by opting in to get their Medicare Summary Notices electronically. If a claim for them gets a high score, Medicare may review or temporarily pause it and will contact the person by email or phone. The person can confirm the claim or correct mistakes. After an alert, Medicare will send faster electronic notices for three months, and it can replace a Medicare card if needed to prevent fraud .

• Who is affected: Medicare patients who opt in, and suppliers/providers of medical equipment and lab tests.
• What changes: A risk-scoring tool helps flag unusual claims, using factors like no prior relationship between patient and provider, odd billing spikes, changes to bank info, or ownership changes. The program requires testing of the tool, clear notices about data use, and coordination with federal watchdogs; in some cases, notice can be forgone if appropriate .
• When: Runs for 2 years, starting no later than January 1, 2026.