US SB2066

Establishes a 2-year pilot program beginning no later than January 1, 2026, to test predictive risk-scoring algorithms for detecting fraudulent Medicare claims involving durable medical equipment and clinical diagnostic laboratory tests

Participation is voluntary for Medicare beneficiaries who have opted in to receive electronic Medicare Summary Notices; participants may terminate at any time

Algorithm scores transactions from 1 (least risky) to 99 (most risky) based on factors including absence of prior patient-provider relationship, aberrant billing patterns, electronic fund transfer changes, and provider ownership changes

High-risk transactions may be suspended pending beneficiary review; beneficiaries receive automatic electronic alerts and bi-weekly Medicare Summary Notices for 3 months following a suspended transaction, with information on reporting suspected fraud

Requires human review for any account or transaction suspension, collaboration with industry representatives including durable medical equipment suppliers, and coordination with the HHS Office of Inspector General