Medicare Transaction Fraud Prevention Act

Voluntary Participation: Beneficiaries have the choice to participate in the pilot program on a voluntary basis and can choose to stop participating at any time (Section 2, (3)(B)(ii) and (3)(C)).

Ability to Correct Errors: If a transaction is suspended due to a high-risk score, beneficiaries are given the opportunity to cure the score or confirm the transaction via email or phone call (Section 2, (6)(C)(ii)).

Increased Monitoring and Alerts: For suspended transactions, the program includes an automatic alert via an electronic Medicare Summary Notice and requires subsequent notices to be sent in two-week intervals for three months (Section 2, (6)(C)(iii)).

Fraud Reporting Information: Medicare Summary Notices may include information explaining how a beneficiary can report suspected fraud to law enforcement (Section 2, (6)(C)(iii)).

Transaction Suspensions: Transactions identified by the algorithm as exceeding a specific risk level may be reviewed for potential suspension (Section 2, (6)(C)(i)).

Risk of Card Termination: The Secretary is granted the authority to determine when a Medicare card must be terminated or a new card issued to prevent fraud and abuse (Section 2, (6)(D)).

Potential for Notice Waivers: The Secretary has the ability to waive or forgo providing notice to a beneficiary or provider regarding the use of the algorithm (Section 2, (6)(B)(iii)).