Medicare Fraud Detection and Deterrence Act of 2025
This bill requires the Centers for Medicare & Medicaid Services (CMS) to deactivate the standard unique health identifiers of health care providers that are excluded from federal health care programs because of fraud, waste, or abuse.
The bill also requires (1) any data submitted by Medicare Advantage plans with respect to durable medical equipment, prosthetics or orthotics, laboratory tests, imaging tests, or home health services to include the standard unique health identifier of the associated provider or supplier; and (2) health care practitioners who are employed by or contract with telehealth companies to use a specialized claims modifier (developed by CMS) for Medicare telehealth services.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1784 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1784
To amend titles XI and XVIII of the Social Security Act to strengthen
health care waste, fraud, and abuse provisions.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 3, 2025
Mr. Doggett introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend titles XI and XVIII of the Social Security Act to strengthen
health care waste, fraud, and abuse provisions.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Fraud Detection and
Deterrence Act of 2025''.
SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, AND ABUSE PROVISIONS.
(a) Deactivation of National Provider Identifier for Certain
Excluded Entities.--Section 1173(b) of the Social Security Act (42
U.S.C. 1320d-2(b)) is amended by adding at the end the following new
paragraph:
``(3) Mandatory deactivation of certain identifiers.--
``(A) In general.--Not later than 180 days after
the date of the enactment of this paragraph, the
Secretary shall revise the standards adopted under
paragraph (1) to provide for--
``(i) the deactivation of a standard unique
health identifier of entity type 1 (as defined
for purposes of such standards) assigned to an
entity if such entity is excluded from
participation in any Federal health care
program under section 1128 or 1128A;
``(ii) the deactivation of a standard
unique health identifier of entity type 2 (as
defined for purposes of such standards)
assigned to an entity if such entity is so
excluded, but only if--
``(I) the Inspector General of the
Department of Health and Human Services
submits to the Secretary a request for
such deactivation; and
``(II) the Secretary determines
such deactivation to be appropriate;
and
``(iii) the reactivation of a standard
unique health identifier deactivated pursuant
to clause (i) or (ii) at the end of such
deactivation (as described in subparagraph
(B)).
``(B) Term of deactivation.--A deactivation
described in subparagraph (A) made with respect to an
entity excluded from participation in any Federal
health care program under section 1128 or 1128A shall
begin on the date of such exclusion and shall end on
the date such exclusion is terminated.
``(C) Nonapplication of deactivation.--
Notwithstanding subparagraph (A), no deactivation of a
standard unique health identifier assigned to an entity
excluded from participation in any Federal health care
program under section 1128 or 1128A shall be made
pursuant to such subparagraph if the Secretary has
waived such exclusion with respect to any Federal
health care program pursuant to section 1128(c)(3)(B).
``(D) Annual review of exclusion list.--Not later
than 1 year after the date of the enactment of this
paragraph and not less frequently than annually
thereafter, the Secretary shall compare the list of
individuals and entities excluded from participation in
any Federal health care program under section 1128 or
1128A maintained by the Inspector General of the
Department of Health and Human Services (or a successor
list) with a list of active standard unique health
identifiers described in subparagraph (A) to ensure
compliance with such subparagraph.''.
(b) Medicare Advantage Plan Provision of National Provider
Identifier for Certain Items and Services.--Section 1859 of the Social
Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the
following new subsection:
``(j) Provision of National Provider Identifier for Certain Items
and Services.--
``(1) In general.--In the case of any encounter data
submitted by a Medicare Advantage plan with respect to a
designated item or service furnished to an individual under
such plan on or after the date of the enactment of this
subsection, the Secretary shall require that such data include
the standard unique health identifier established pursuant to
standards described in section 1173(b) of the provider of
services or supplier that ordered such item or service or
referred such individual for such item or service.
``(2) Rejection of data.--The Secretary shall reject any
encounter data submitted by a Medicare Advantage plan if--
``(A) such data does not comply with the
requirement described in paragraph (1); or
``(B) the Secretary determines that a standard
unique health identifier included in such data in
accordance with such requirement is not active or is
otherwise invalid.
``(3) Definition of designated item or service.--For
purposes of this subsection, the term `designated item or
service' means any of the following:
``(A) An item of durable medical equipment.
``(B) A prosthetic or orthotic device.
``(C) A clinical diagnostic laboratory test.
``(D) A diagnostic imaging test (as specified by
the Secretary).
``(E) A home health service (as specified by the
Secretary).''.
(c) Identification of Relationships Between Telehealth Suppliers
and Telehealth Companies Under Medicare.--Section 1834(m) of the Social
Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the
following new paragraph:
``(10) Identification of relationships between telehealth
suppliers and telehealth companies.--
``(A) In general.--In the case of a telehealth
service furnished on or after the date that is 180 days
after the date of the enactment of this paragraph by a
specified entity, no payment may be made under this
section for such service unless the claim for such
service includes the modifier established pursuant to
subparagraph (B).
``(B) Establishment of modifier.--Not later than
180 days after the date of the enactment of this
paragraph, the Secretary shall establish a claims
modifier for purposes of identifying telehealth
services payable under this section furnished by a
specified entity (as defined in subparagraph (C)).
``(C) Definitions.--In this section:
``(i) Specified entity.--The term
`specified entity' means a physician or
practitioner (as such terms are defined in
paragraph (4)) that has an employment or other
contractual relationship in effect with a
telehealth company relating to the furnishing
telehealth services.
``(ii) Telehealth company.--The term
`telehealth company' means an entity--
``(I) that employs or otherwise
contracts with physicians or
practitioners to furnish telehealth
services; and
``(II) that does not employ or
otherwise contract with any physician
or practitioner to furnish items and
services in-person (or that employs or
otherwise contracts with physicians or
practitioners to furnish such in-person
items and services in a de minimis
manner compared to the amount of
telehealth services furnished by such
physicians or practitioners, as
specified by the Secretary).''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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