Bill · H.R. 3996· House(119-HR-3996)
Medicare Transaction Fraud Prevention Act
- Introduced
- 6/12/2025
- Last activity
- 6/12/2025 — Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Sponsored by
- David Schweikert
- Cosponsors
- None
- Introduced
- In Committee
What this bill would do
The Medicare Transaction Fraud Prevention Act aims to amend the Social Security Act to create a specific pilot program. This program tests the use of predictive risk-scoring algorithms to oversee payments for clinical diagnostic laboratory tests and durable medical equipment under Medicare. The Secretary of Health and Human Services is tasked with establishing this program, which is intended to run for a period of two years starting no later than January 1, 2026. Participation in this pilot program is voluntary for beneficiaries who have opted into receiving electronic Medicare Summary Notices. The program utilizes algorithms to score transactions from 1 to 99 based on risk factors to help identify potential fraud.
Yes· 3 of 9
Does this reduce what the federal government spends?+1
The bill aims to prevent fraud and abuse in Medicare payments, which can lead to more efficient government spending.
Does this make the government pay for what it commits to?+1
By targeting fraud in durable medical equipment and laboratory tests, the bill promotes more responsible use of Medicare funds.
Does this give people more protection from unfair business practices?+1
The program aims to protect beneficiaries from fraudulent transactions involving medical equipment and laboratory tests.
The opposite
Does this give the government more power to monitor people inside the country?-2
The use of predictive algorithms to monitor Medicare transactions may be viewed as an increase in domestic surveillance of beneficiary data.
Does this protect people from being watched or searched?-1
The use of personal data for predictive risk scoring may impact individual privacy rights.
Does this give people more control over their personal data?-1
The pilot program requires using beneficiary data to train algorithms, which may raise data privacy concerns.
Who it would affect, and how
Potential Positive Impacts for People
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Voluntary Participation: Individuals have the choice to participate in the pilot program on a voluntary basis and can end their participation at any time (Section 2, subsection (3)(B)(C)).
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Ability to Correct Errors: Beneficiaries are provided the opportunity to respond via email or phone to cure a high-risk score or a suspended transaction if they believe the score was based on inaccurate data (Section 2, subsection (6)(C)(ii)).
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Transparency and Notification: The Secretary must establish methods for notifying beneficiaries and providers about how the algorithm is used, including how their data is collected and processed (Section 2, subsection (6)(B)(ii)).
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Automated Alerts: If a transaction is suspended, an automatic alert is sent to the beneficiary through an electronic Medicare Summary Notice (Section 2, subsection (6)(C)(iii)(I)).
Potential Negative Impacts for People
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Transaction Suspensions: Transactions flagged with a risk score exceeding a level specified by the Secretary may be subject to review for suspension (Section 2, subsection (6)(C)(i)).
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Increased Monitoring: Following a transaction suspension, all subsequent Medicare Summary Notices involving that transaction must be sent electronically in two-week intervals for a period of three months (Section 2, subsection (6)(C)(iii)(II)).
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Data Usage: The program relies on the use of beneficiary data to train and implement the predictive risk-scoring algorithm (Section 2, subsection (6)(A)).
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Potential for Notice Waiver: The Secretary has the ability to waive or forgo notice to a beneficiary or provider regarding the use of the algorithm if deemed appropriate (Section 2, subsection (6)(B)(iii)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Economy And Finance
- Improves Consumer Protection+1Improves Fiscal Responsibility+1Reduces Government Spending+1
- Demographic And Interest Groups
- Good For Retirees+1Good For Seniors+1
- Governance And Ideology
- Improves Due Process+1Improves Government Transparency+1Increases Federal Power+1Improves Privacy Rights-1
- National Security And Foreign Policy
- Increases Domestic Surveillance-2
- Education And Technology
- Improves Data Privacy-1
- Social Issues And Justice
- Improves Social Security+1
- 6/12/2025
- Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Introduced in House
One bill Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.