Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1784 Compare Versions

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Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1784
5	5	To amend titles XI and XVIII of the Social Security Act to strengthen
6	6	health care waste, fraud, and abuse provisions.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	MARCH3, 2025
9	9	Mr. D
10	10	OGGETTintroduced the following bill; which was referred to the Com-
11	11	mittee on Energy and Commerce, and in addition to the Committee on
12	12	Ways and Means, for a period to be subsequently determined by the
13	13	Speaker, in each case for consideration of such provisions as fall within
14	14	the jurisdiction of the committee concerned
15	15	A BILL
16	16	To amend titles XI and XVIII of the Social Security Act
17	17	to strengthen health care waste, fraud, and abuse provisions.
18	18	Be it enacted by the Senate and House of Representa-1
19	19	tives of the United States of America in Congress assembled, 2
20	20	SECTION 1. SHORT TITLE. 3
21	21	This Act may be cited as the ‘‘Medicare Fraud Detec-4
22	22	tion and Deterrence Act of 2025’’. 5
23	23	SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, 6
24	24	AND ABUSE PROVISIONS. 7
25	25	(a) D
26	26	EACTIVATION OFNATIONALPROVIDERIDENTI-8
27	27	FIER FOR CERTAINEXCLUDED ENTITIES.—Section 9
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31	31	1173(b) of the Social Security Act (42 U.S.C. 1320d– 1
32	32	2(b)) is amended by adding at the end the following new 2
33	33	paragraph: 3
34	34	‘‘(3) M
35	35	ANDATORY DEACTIVATION OF CERTAIN 4
36	36	IDENTIFIERS.— 5
37	37	‘‘(A) I
38	38	N GENERAL.—Not later than 180 6
39	39	days after the date of the enactment of this 7
40	40	paragraph, the Secretary shall revise the stand-8
41	41	ards adopted under paragraph (1) to provide 9
42	42	for— 10
43	43	‘‘(i) the deactivation of a standard 11
44	44	unique health identifier of entity type 1 (as 12
45	45	defined for purposes of such standards) as-13
46	46	signed to an entity if such entity is ex-14
47	47	cluded from participation in any Federal 15
48	48	health care program under section 1128 or 16
49	49	1128A; 17
50	50	‘‘(ii) the deactivation of a standard 18
51	51	unique health identifier of entity type 2 (as 19
52	52	defined for purposes of such standards) as-20
53	53	signed to an entity if such entity is so ex-21
54	54	cluded, but only if— 22
55	55	‘‘(I) the Inspector General of the 23
56	56	Department of Health and Human 24
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60	60	Services submits to the Secretary a 1
61	61	request for such deactivation; and 2
62	62	‘‘(II) the Secretary determines 3
63	63	such deactivation to be appropriate; 4
64	64	and 5
65	65	‘‘(iii) the reactivation of a standard 6
66	66	unique health identifier deactivated pursu-7
67	67	ant to clause (i) or (ii) at the end of such 8
68	68	deactivation (as described in subparagraph 9
69	69	(B)). 10
70	70	‘‘(B) T
71	71	ERM OF DEACTIVATION .—A deacti-11
72	72	vation described in subparagraph (A) made 12
73	73	with respect to an entity excluded from partici-13
74	74	pation in any Federal health care program 14
75	75	under section 1128 or 1128A shall begin on the 15
76	76	date of such exclusion and shall end on the date 16
77	77	such exclusion is terminated. 17
78	78	‘‘(C) N
79	79	ONAPPLICATION OF DEACTIVA -18
80	80	TION.—Notwithstanding subparagraph (A), no 19
81	81	deactivation of a standard unique health identi-20
82	82	fier assigned to an entity excluded from partici-21
83	83	pation in any Federal health care program 22
84	84	under section 1128 or 1128A shall be made 23
85	85	pursuant to such subparagraph if the Secretary 24
86	86	has waived such exclusion with respect to any 25
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90	90	Federal health care program pursuant to sec-1
91	91	tion 1128(c)(3)(B). 2
92	92	‘‘(D) A
93	93	NNUAL REVIEW OF EXCLUSION 3
94	94	LIST.—Not later than 1 year after the date of 4
95	95	the enactment of this paragraph and not less 5
96	96	frequently than annually thereafter, the Sec-6
97	97	retary shall compare the list of individuals and 7
98	98	entities excluded from participation in any Fed-8
99	99	eral health care program under section 1128 or 9
100	100	1128A maintained by the Inspector General of 10
101	101	the Department of Health and Human Services 11
102	102	(or a successor list) with a list of active stand-12
103	103	ard unique health identifiers described in sub-13
104	104	paragraph (A) to ensure compliance with such 14
105	105	subparagraph.’’. 15
106	106	(b) M
107	107	EDICAREADVANTAGEPLANPROVISION OFNA-16
108	108	TIONALPROVIDERIDENTIFIER FORCERTAINITEMS AND 17
109	109	S
110	110	ERVICES.—Section 1859 of the Social Security Act (42 18
111	111	U.S.C. 1395w–28) is amended by adding at the end the 19
112	112	following new subsection: 20
113	113	‘‘(j) P
114	114	ROVISION OFNATIONALPROVIDERIDENTI-21
115	115	FIER FORCERTAINITEMS ANDSERVICES.— 22
116	116	‘‘(1) I
117	117	N GENERAL.—In the case of any encoun-23
118	118	ter data submitted by a Medicare Advantage plan 24
119	119	with respect to a designated item or service fur-25
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123	123	nished to an individual under such plan on or after 1
124	124	the date of the enactment of this subsection, the 2
125	125	Secretary shall require that such data include the 3
126	126	standard unique health identifier established pursu-4
127	127	ant to standards described in section 1173(b) of the 5
128	128	provider of services or supplier that ordered such 6
129	129	item or service or referred such individual for such 7
130	130	item or service. 8
131	131	‘‘(2) R
132	132	EJECTION OF DATA .—The Secretary 9
133	133	shall reject any encounter data submitted by a Medi-10
134	134	care Advantage plan if— 11
135	135	‘‘(A) such data does not comply with the 12
136	136	requirement described in paragraph (1); or 13
137	137	‘‘(B) the Secretary determines that a 14
138	138	standard unique health identifier included in 15
139	139	such data in accordance with such requirement 16
140	140	is not active or is otherwise invalid. 17
141	141	‘‘(3) D
142	142	EFINITION OF DESIGNATED ITEM OR 18
143	143	SERVICE.—For purposes of this subsection, the term 19
144	144	‘designated item or service’ means any of the fol-20
145	145	lowing: 21
146	146	‘‘(A) An item of durable medical equip-22
147	147	ment. 23
148	148	‘‘(B) A prosthetic or orthotic device. 24
149	149	‘‘(C) A clinical diagnostic laboratory test. 25
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153	153	‘‘(D) A diagnostic imaging test (as speci-1
154	154	fied by the Secretary). 2
155	155	‘‘(E) A home health service (as specified 3
156	156	by the Secretary).’’. 4
157	157	(c) I
158	158	DENTIFICATION OF RELATIONSHIPSBETWEEN 5
159	159	T
160	160	ELEHEALTHSUPPLIERS ANDTELEHEALTHCOMPANIES 6
161	161	U
162	162	NDERMEDICARE.—Section 1834(m) of the Social Secu-7
163	163	rity Act (42 U.S.C. 1395m(m)) is amended by adding at 8
164	164	the end the following new paragraph: 9
165	165	‘‘(10) I
166	166	DENTIFICATION OF RELATIONSHIPS BE -10
167	167	TWEEN TELEHEALTH SUPPLIERS AND TELEHEALTH 11
168	168	COMPANIES.— 12
169	169	‘‘(A) I
170	170	N GENERAL.—In the case of a tele-13
171	171	health service furnished on or after the date 14
172	172	that is 180 days after the date of the enact-15
173	173	ment of this paragraph by a specified entity, no 16
174	174	payment may be made under this section for 17
175	175	such service unless the claim for such service 18
176	176	includes the modifier established pursuant to 19
177	177	subparagraph (B). 20
178	178	‘‘(B) E
179	179	STABLISHMENT OF MODIFIER .—Not 21
180	180	later than 180 days after the date of the enact-22
181	181	ment of this paragraph, the Secretary shall es-23
182	182	tablish a claims modifier for purposes of identi-24
183	183	fying telehealth services payable under this sec-25
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187	187	tion furnished by a specified entity (as defined 1
188	188	in subparagraph (C)). 2
189	189	‘‘(C) D
190	190	EFINITIONS.—In this section: 3
191	191	‘‘(i) S
192	192	PECIFIED ENTITY.—The term 4
193	193	‘specified entity’ means a physician or 5
194	194	practitioner (as such terms are defined in 6
195	195	paragraph (4)) that has an employment or 7
196	196	other contractual relationship in effect with 8
197	197	a telehealth company relating to the fur-9
198	198	nishing telehealth services. 10
199	199	‘‘(ii) T
200	200	ELEHEALTH COMPANY .—The 11
201	201	term ‘telehealth company’ means an enti-12
202	202	ty— 13
203	203	‘‘(I) that employs or otherwise 14
204	204	contracts with physicians or practi-15
205	205	tioners to furnish telehealth services; 16
206	206	and 17
207	207	‘‘(II) that does not employ or 18
208	208	otherwise contract with any physician 19
209	209	or practitioner to furnish items and 20
210	210	services in-person (or that employs or 21
211	211	otherwise contracts with physicians or 22
212	212	practitioners to furnish such in-person 23
213	213	items and services in a de minimis 24
214	214	manner compared to the amount of 25
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218	218	telehealth services furnished by such 1
219	219	physicians or practitioners, as speci-2
220	220	fied by the Secretary).’’. 3
221	221	Æ
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