119-hr1784

[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).''.
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