Bills would provide more oversight of DME
By HME News Staff
Updated 9:08 AM CDT, Thu June 26, 2025
WASHINGTON - New legislation introduced in the House of Representatives 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, AAHomecare has reported.
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 Medicare Transaction Fraud Prevention Act (S. 2066 & H.R. 3996), introduced June 12, also instructs the Department of Health and Human Services to work with industry representatives, including DME suppliers, on the development and implementation of the pilot program.
AAHomecare says it 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.
Read the text of the bill here.
Comments