Predictive Risk Scoring Pilot Bills Introduced in House, Senate

WASHINGTON—New legislation (S 2066) 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 (DME) 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 the Department of Health and Human Services to work with industry representatives, including DME suppliers, on the development and implementation of the pilot program.