I
119THCONGRESS
1
STSESSION 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
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 title XVIII of the Social Security Act to establish
requirements for the provision of certain high-cost dura-
ble medical equipment and laboratory testing, and for
other purposes.
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 ‘‘Preventing Medicare 4
Telefraud Act’’. 5
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SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU-1
RABLE MEDICAL EQUIPMENT AND LABORA-2
TORY TESTS. 3
(a) H
IGH-COSTDURABLEMEDICALEQUIPMENT.— 4
Section 1834(a)(1)(E) of the Social Security Act (42 5
U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 6
the following new clause: 7
‘‘(vi) S
TANDARDS FOR HIGH -COST DU-8
RABLE MEDICAL EQUIPMENT .— 9
‘‘(I) L
IMITATION ON PAYMENT 10
FOR HIGH-COST DURABLE MEDICAL 11
EQUIPMENT.—Payment may not be 12
made under this subsection for a 13
high-cost durable medical equipment 14
ordered by a physician or other practi-15
tioner described in clause (ii) via tele-16
health for an individual on or after 17
the date that is 180 days after the 18
date of the enactment of this clause, 19
unless such physician or practitioner 20
furnished to such individual a service 21
in-person at least once during the 6 22
month period prior to ordering such 23
high-cost durable medical equipment. 24
‘‘(II) H
IGH-COST DURABLE MED -25
ICAL EQUIPMENT DETERMINATION .— 26
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For purposes of this clause, the Ad-1
ministrator of the Centers for Medi-2
care & Medicaid Services shall define 3
the term ‘high-cost durable medical 4
equipment’ and specify the durable 5
medical equipment for which such def-6
inition shall apply. 7
‘‘(vii) A
UDIT OF PROVIDERS AND 8
PRACTITIONERS FURNISHING A HIGH VOL -9
UME OF DURABLE MEDICAL EQUIPMENT 10
VIA TELEHEALTH.— 11
‘‘(I) I
DENTIFICATION OF PRO -12
VIDERS.—Beginning 6 months after 13
the date of the enactment of this 14
clause, Medicare administrative con-15
tractors shall conduct reviews on a 16
schedule determined by the Secretary, 17
of claims for durable medical equip-18
ment prescribed by a physician or 19
other practitioner described in clause 20
(ii) during the 12 month period pre-21
ceding such review to identify physi-22
cians or other practitioners with re-23
spect to whom at least 90 percent of 24
all durable medical equipment pre-25
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scribed by such physician or practi-1
tioner during such period was pre-2
scribed pursuant to a telehealth visit. 3
‘‘(II) A
UDIT.—In the case of a 4
physician or practitioner identified 5
under subclause (I), with respect to a 6
period described in such subclause, 7
the Medicare administrative contrac-8
tors shall conduct audits of all claims 9
for durable medical equipment pre-10
scribed by such physicians or practi-11
tioners to determine whether such 12
claims comply with the requirements 13
for coverage under this title.’’. 14
(b) H
IGH-COSTLABORATORY TESTS.—Section 15
1834A(b) of the Social Security Act (42 U.S.C. 1395m– 16
1(b)) is amended by adding at the end the following new 17
paragraph: 18
‘‘(6) R
EQUIREMENT FOR HIGH -COST LABORA-19
TORY TESTS.— 20
‘‘(A) L
IMITATION ON PAYMENT FOR HIGH - 21
COST LABORATORY TESTS .—Payment may not 22
be made under this subsection for a high-cost 23
laboratory test ordered by a physician or practi-24
tioner via telehealth for an individual on or 25
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after the date that is 180 days after the date 1
of the enactment of this paragraph, unless such 2
physician or practitioner furnished to such indi-3
vidual a service in-person at least once during 4
the 6 month period prior to ordering such high- 5
cost laboratory test. 6
‘‘(B) H
IGH-COST LABORATORY TEST DE -7
FINED.—For purposes of this paragraph, the 8
Administrator for the Centers for Medicare & 9
Medicaid Services shall define the term ‘high- 10
cost laboratory test’ and specify which labora-11
tory tests such definition shall apply to. 12
‘‘(7) A
UDIT OF LABORATORY TESTING OR -13
DERED PURSUANT TO TELEHEALTH VISIT .— 14
‘‘(A) I
DENTIFICATION OF PROVIDERS .— 15
Beginning 6 months after the date of the enact-16
ment of this paragraph, Medicare administra-17
tive contractors shall conduct periodic reviews 18
on a schedule determined by the Secretary, of 19
claims for laboratory tests prescribed by a phy-20
sician or practitioner during the 12 month pe-21
riod preceding such review to identify physi-22
cians or other practitioners with respect to 23
whom at least 90 percent of all laboratory tests 24
prescribed by such physician or practitioner 25
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during such period was prescribed pursuant to 1
a telehealth visit. 2
‘‘(B) A
UDIT.—In the case of a physician 3
or practitioner identified under subparagraph 4
(A), with respect to a period described in such 5
subparagraph, the Medicare administrative con-6
tractors shall conduct audits of all claims for 7
laboratory tests prescribed by such physicians 8
or practitioners during such period beginning to 9
determine whether such claims comply with the 10
requirements for coverage under this title.’’. 11
SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA-12
RATELY BILLABLE TELEHEALTH SERVICES. 13
Section 1834(m) of the Social Security Act (42 14
U.S.C. 1395m(m)) is amended by adding at the end the 15
following new paragraph: 16
‘‘(10) R
EQUIREMENT TO SUBMIT NPI NUMBER 17
FOR SEPARATELY BILLABLE TELEHEALTH SERV -18
ICES.—Payment may not be made under this sub-19
section for separately billable telehealth services fur-20
nished on or after the date that is 180 days after 21
the date of the enactment of this paragraph by a 22
physician or practitioner unless such physician or 23
practitioner submits a claim for payment under the 24
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national provider identification number assigned to 1
such physician or practitioner.’’. 2
Æ
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