WASHINGTON, D.C. – New legislation introduced in the House and Senate would create a pilot program for testing the use of a predictive risk-scoring algorithm to provide oversight of payments for durable medical equipment and clinical diagnostic laboratory tests under the Medicare program.
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 that appears to be irregular. That data would allow human inspectors to prioritize reviews of transactions that are most likely to be fraudulent.
The legislation also instructs HHS to work with industry representatives, including DME suppliers, on the development and implementation of the pilot program. AAHomecare supports testing this new approach to identify attempts to defraud the Medicare program, especially where they can help catch emerging fraud schemes before they are widely implemented.
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