Ways and Means Committee, Energy and Commerce Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This legislation establishes new requirements under Medicare to prevent potential fraud and abuse associated with certain services delivered via telehealth, focusing on high-cost durable medical equipment and laboratory tests. It aims to ensure a necessary level of in-person patient interaction for these specific items. A key provision prohibits Medicare payment for high-cost durable medical equipment or laboratory tests ordered through telehealth unless the ordering physician or practitioner has provided an in-person service to the patient within the preceding six months. The Centers for Medicare & Medicaid Services (CMS) Administrator will define what constitutes "high-cost" for these items, with these payment restrictions taking effect 180 days after enactment. The bill also mandates that Medicare administrative contractors audit providers who prescribe a high volume of durable medical equipment or laboratory tests predominantly via telehealth, specifically those with 90 percent or more telehealth-based prescriptions over a 12-month period. Additionally, physicians and practitioners will be required to submit their National Provider Identification (NPI) number for all separately billable telehealth services to enhance accountability and tracking.
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.
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.
Health
Preventing Medicare Telefraud Act
USA119th CongressHR-1785| House
| Updated: 3/3/2025
This legislation establishes new requirements under Medicare to prevent potential fraud and abuse associated with certain services delivered via telehealth, focusing on high-cost durable medical equipment and laboratory tests. It aims to ensure a necessary level of in-person patient interaction for these specific items. A key provision prohibits Medicare payment for high-cost durable medical equipment or laboratory tests ordered through telehealth unless the ordering physician or practitioner has provided an in-person service to the patient within the preceding six months. The Centers for Medicare & Medicaid Services (CMS) Administrator will define what constitutes "high-cost" for these items, with these payment restrictions taking effect 180 days after enactment. The bill also mandates that Medicare administrative contractors audit providers who prescribe a high volume of durable medical equipment or laboratory tests predominantly via telehealth, specifically those with 90 percent or more telehealth-based prescriptions over a 12-month period. Additionally, physicians and practitioners will be required to submit their National Provider Identification (NPI) number for all separately billable telehealth services to enhance accountability and tracking.
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.
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.