Medicare Fraud Detection and Deterrence Act of 2023
Impact
The introduction of HB 1745 is poised to significantly fortify the mechanisms in place that combat fraud in the healthcare system. This move is hailed as a vital reform, ensuring that entities previously implicated in fraudulent activities cannot continue to exploit Medicare-related services. Additionally, the bill introduces a requirement for the Secretary of Health and Human Services to regularly review and update the exclusion list, ensuring ongoing vigilance against potential fraudsters. By implementing such stringent measures, the bill is expected to bolster trust in federal health programs and enhance the integrity of medical services funded by taxpayer dollars.
Summary
House Bill 1745, known as the Medicare Fraud Detection and Deterrence Act of 2023, aims to amend titles XI and XVIII of the Social Security Act to enhance provisions against healthcare waste, fraud, and abuse. The bill targets the deactivation of identifiers for health entities that are excluded from participation in federal healthcare programs, thereby preventing fraudulent actors from continuing to operate under false pretenses. Specifically, the bill mandates that certain identifiers be deactivated within 90 days of an entity's exclusion from program participation, which is a significant step toward tightening controls within Medicare and Medicaid frameworks.
Contention
While proponents argue that these measures are necessary for protecting the Medicare system from fraud, there are concerns about the practical implications of swiftly deactivating identifiers. Some stakeholders fear that this could lead to unintended consequences for legitimate healthcare providers who may face administrative hurdles in reinstating their identifiers if they become inadvertently implicated in any fraudulent activity. Additionally, the requirement for telehealth services to include specific identifiers adds a layer of complexity to how these services are billed and recorded, which could impact efficiency and accessibility for patients relying on telehealth options.
Medicare Fraud Detection and Deterrence Act of 2025This 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.