I
119THCONGRESS
1
STSESSION 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
MARCH3, 2025
Mr. D
OGGETTintroduced the following bill; which was referred to the Com-
mittee 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Medicare Fraud Detec-4
tion and Deterrence Act of 2025’’. 5
SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, 6
AND ABUSE PROVISIONS. 7
(a) D
EACTIVATION OFNATIONALPROVIDERIDENTI-8
FIER FOR CERTAINEXCLUDED ENTITIES.—Section 9
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1173(b) of the Social Security Act (42 U.S.C. 1320d– 1
2(b)) is amended by adding at the end the following new 2
paragraph: 3
‘‘(3) M
ANDATORY DEACTIVATION OF CERTAIN 4
IDENTIFIERS.— 5
‘‘(A) I
N GENERAL.—Not later than 180 6
days after the date of the enactment of this 7
paragraph, the Secretary shall revise the stand-8
ards adopted under paragraph (1) to provide 9
for— 10
‘‘(i) the deactivation of a standard 11
unique health identifier of entity type 1 (as 12
defined for purposes of such standards) as-13
signed to an entity if such entity is ex-14
cluded from participation in any Federal 15
health care program under section 1128 or 16
1128A; 17
‘‘(ii) the deactivation of a standard 18
unique health identifier of entity type 2 (as 19
defined for purposes of such standards) as-20
signed to an entity if such entity is so ex-21
cluded, but only if— 22
‘‘(I) the Inspector General of the 23
Department of Health and Human 24
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Services submits to the Secretary a 1
request for such deactivation; and 2
‘‘(II) the Secretary determines 3
such deactivation to be appropriate; 4
and 5
‘‘(iii) the reactivation of a standard 6
unique health identifier deactivated pursu-7
ant to clause (i) or (ii) at the end of such 8
deactivation (as described in subparagraph 9
(B)). 10
‘‘(B) T
ERM OF DEACTIVATION .—A deacti-11
vation described in subparagraph (A) made 12
with respect to an entity excluded from partici-13
pation in any Federal health care program 14
under section 1128 or 1128A shall begin on the 15
date of such exclusion and shall end on the date 16
such exclusion is terminated. 17
‘‘(C) N
ONAPPLICATION OF DEACTIVA -18
TION.—Notwithstanding subparagraph (A), no 19
deactivation of a standard unique health identi-20
fier assigned to an entity excluded from partici-21
pation in any Federal health care program 22
under section 1128 or 1128A shall be made 23
pursuant to such subparagraph if the Secretary 24
has waived such exclusion with respect to any 25
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Federal health care program pursuant to sec-1
tion 1128(c)(3)(B). 2
‘‘(D) A
NNUAL REVIEW OF EXCLUSION 3
LIST.—Not later than 1 year after the date of 4
the enactment of this paragraph and not less 5
frequently than annually thereafter, the Sec-6
retary shall compare the list of individuals and 7
entities excluded from participation in any Fed-8
eral health care program under section 1128 or 9
1128A maintained by the Inspector General of 10
the Department of Health and Human Services 11
(or a successor list) with a list of active stand-12
ard unique health identifiers described in sub-13
paragraph (A) to ensure compliance with such 14
subparagraph.’’. 15
(b) M
EDICAREADVANTAGEPLANPROVISION OFNA-16
TIONALPROVIDERIDENTIFIER FORCERTAINITEMS AND 17
S
ERVICES.—Section 1859 of the Social Security Act (42 18
U.S.C. 1395w–28) is amended by adding at the end the 19
following new subsection: 20
‘‘(j) P
ROVISION OFNATIONALPROVIDERIDENTI-21
FIER FORCERTAINITEMS ANDSERVICES.— 22
‘‘(1) I
N GENERAL.—In the case of any encoun-23
ter data submitted by a Medicare Advantage plan 24
with respect to a designated item or service fur-25
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nished to an individual under such plan on or after 1
the date of the enactment of this subsection, the 2
Secretary shall require that such data include the 3
standard unique health identifier established pursu-4
ant to standards described in section 1173(b) of the 5
provider of services or supplier that ordered such 6
item or service or referred such individual for such 7
item or service. 8
‘‘(2) R
EJECTION OF DATA .—The Secretary 9
shall reject any encounter data submitted by a Medi-10
care Advantage plan if— 11
‘‘(A) such data does not comply with the 12
requirement described in paragraph (1); or 13
‘‘(B) the Secretary determines that a 14
standard unique health identifier included in 15
such data in accordance with such requirement 16
is not active or is otherwise invalid. 17
‘‘(3) D
EFINITION OF DESIGNATED ITEM OR 18
SERVICE.—For purposes of this subsection, the term 19
‘designated item or service’ means any of the fol-20
lowing: 21
‘‘(A) An item of durable medical equip-22
ment. 23
‘‘(B) A prosthetic or orthotic device. 24
‘‘(C) A clinical diagnostic laboratory test. 25
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‘‘(D) A diagnostic imaging test (as speci-1
fied by the Secretary). 2
‘‘(E) A home health service (as specified 3
by the Secretary).’’. 4
(c) I
DENTIFICATION OF RELATIONSHIPSBETWEEN 5
T
ELEHEALTHSUPPLIERS ANDTELEHEALTHCOMPANIES 6
U
NDERMEDICARE.—Section 1834(m) of the Social Secu-7
rity Act (42 U.S.C. 1395m(m)) is amended by adding at 8
the end the following new paragraph: 9
‘‘(10) I
DENTIFICATION OF RELATIONSHIPS BE -10
TWEEN TELEHEALTH SUPPLIERS AND TELEHEALTH 11
COMPANIES.— 12
‘‘(A) I
N GENERAL.—In the case of a tele-13
health service furnished on or after the date 14
that is 180 days after the date of the enact-15
ment of this paragraph by a specified entity, no 16
payment may be made under this section for 17
such service unless the claim for such service 18
includes the modifier established pursuant to 19
subparagraph (B). 20
‘‘(B) E
STABLISHMENT OF MODIFIER .—Not 21
later than 180 days after the date of the enact-22
ment of this paragraph, the Secretary shall es-23
tablish a claims modifier for purposes of identi-24
fying telehealth services payable under this sec-25
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tion furnished by a specified entity (as defined 1
in subparagraph (C)). 2
‘‘(C) D
EFINITIONS.—In this section: 3
‘‘(i) S
PECIFIED ENTITY.—The term 4
‘specified entity’ means a physician or 5
practitioner (as such terms are defined in 6
paragraph (4)) that has an employment or 7
other contractual relationship in effect with 8
a telehealth company relating to the fur-9
nishing telehealth services. 10
‘‘(ii) T
ELEHEALTH COMPANY .—The 11
term ‘telehealth company’ means an enti-12
ty— 13
‘‘(I) that employs or otherwise 14
contracts with physicians or practi-15
tioners to furnish telehealth services; 16
and 17
‘‘(II) that does not employ or 18
otherwise contract with any physician 19
or practitioner to furnish items and 20
services in-person (or that employs or 21
otherwise contracts with physicians or 22
practitioners to furnish such in-person 23
items and services in a de minimis 24
manner compared to the amount of 25
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telehealth services furnished by such 1
physicians or practitioners, as speci-2
fied by the Secretary).’’. 3
Æ
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