Bipartisan legislation introduced in the Senate on June 13 aims to reduce fraud, waste, and abuse in the Medicare system by harnessing artificial intelligence technologies for that task.
The Medicare Transaction Fraud Prevention Act is being sponsored by Sens. Eric Schmitt, R-Mo., Maggie Hassan, D-N.H., and Tim Sheehy, R-Mont.
Among other provisions, the bill would create a pilot program that would test a “predictive risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program,” the senators offices’ said.
The algorithm would then assign a risk score to all fee-for-service transactions, with high-risk scores assigned for claims billed “at a rate or style deemed irregular.” That data, the senators said, “would allow human inspectors to prioritize reviews of transactions most likely to be fraudulent.”
The senators noted that Medicare beneficiaries can opt into the program, so that data for the pilot program is obtained with consent.
Estimates for Medicare fraud vary widely but are often cited at around $60 billion per year for losses due to fraud, errors, and abuse.
“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,” said. Sen. Schmitt in a statement.
“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,” added Sen. Hassan.
“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,” said Sen. Sheehy.