[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1785 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 1785
To amend title XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost durable medical
equipment and laboratory testing, and for other purposes.
_______________________________________________________________________
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
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A BILL
To amend title XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost durable medical
equipment and laboratory testing, and for other purposes.
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 ``Preventing Medicare Telefraud Act''.
SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DURABLE MEDICAL
EQUIPMENT AND LABORATORY TESTS.
(a) High-Cost Durable Medical Equipment.--Section 1834(a)(1)(E) of
the Social Security Act (42 U.S.C. 1395m(a)(1)(E)) is amended by adding
at the end the following new clause:
``(vi) Standards for high-cost durable
medical equipment.--
``(I) Limitation on payment for
high-cost durable medical equipment.--
Payment may not be made under this
subsection for a high-cost durable
medical equipment ordered by a
physician or other practitioner
described in clause (ii) via telehealth
for an individual on or after the date
that is 180 days after the date of the
enactment of this clause, unless such
physician or practitioner furnished to
such individual a service in-person at
least once during the 6 month period
prior to ordering such high-cost
durable medical equipment.
``(II) High-cost durable medical
equipment determination.--For purposes
of this clause, the Administrator of
the Centers for Medicare & Medicaid
Services shall define the term `high-
cost durable medical equipment' and
specify the durable medical equipment
for which such definition shall apply.
``(vii) Audit of providers and
practitioners furnishing a high volume of
durable medical equipment via telehealth.--
``(I) Identification of
providers.--Beginning 6 months after
the date of the enactment of this
clause, Medicare administrative
contractors shall conduct reviews on a
schedule determined by the Secretary,
of claims for durable medical equipment
prescribed by a physician or other
practitioner described in clause (ii)
during the 12 month period preceding
such review to identify physicians or
other practitioners with respect to
whom at least 90 percent of all durable
medical equipment prescribed by such
physician or practitioner during such
period was prescribed pursuant to a
telehealth visit.
``(II) Audit.--In the case of a
physician or practitioner identified
under subclause (I), with respect to a
period described in such subclause, the
Medicare administrative contractors
shall conduct audits of all claims for
durable medical equipment prescribed by
such physicians or practitioners to
determine whether such claims comply
with the requirements for coverage
under this title.''.
(b) High-Cost Laboratory Tests.--Section 1834A(b) of the Social
Security Act (42 U.S.C. 1395m-1(b)) is amended by adding at the end the
following new paragraph:
``(6) Requirement for high-cost laboratory tests.--
``(A) Limitation on payment for high-cost
laboratory tests.--Payment may not be made under this
subsection for a high-cost laboratory test ordered by a
physician or practitioner via telehealth for an
individual on or after the date that is 180 days after
the date of the enactment of this paragraph, unless
such physician or practitioner furnished to such
individual a service in-person at least once during the
6 month period prior to ordering such high-cost
laboratory test.
``(B) High-cost laboratory test defined.--For
purposes of this paragraph, the Administrator for the
Centers for Medicare & Medicaid Services shall define
the term `high-cost laboratory test' and specify which
laboratory tests such definition shall apply to.
``(7) Audit of laboratory testing ordered pursuant to
telehealth visit.--
``(A) Identification of providers.--Beginning 6
months after the date of the enactment of this
paragraph, Medicare administrative contractors shall
conduct periodic reviews on a schedule determined by
the Secretary, of claims for laboratory tests
prescribed by a physician or practitioner during the 12
month period preceding such review to identify
physicians or other practitioners with respect to whom
at least 90 percent of all laboratory tests prescribed
by such physician or practitioner during such period
was prescribed pursuant to a telehealth visit.
``(B) Audit.--In the case of a physician or
practitioner identified under subparagraph (A), with
respect to a period described in such subparagraph, the
Medicare administrative contractors shall conduct
audits of all claims for laboratory tests prescribed by
such physicians or practitioners during such period
beginning to determine whether such claims comply with
the requirements for coverage under this title.''.
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPARATELY BILLABLE
TELEHEALTH SERVICES.
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) Requirement to submit npi number for separately
billable telehealth services.--Payment may not be made under
this subsection for separately billable telehealth services
furnished on or after the date that is 180 days after the date
of the enactment of this paragraph by a physician or
practitioner unless such physician or practitioner submits a
claim for payment under the national provider identification
number assigned to such physician or practitioner.''.
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