Preventing Medicare Telefraud Act

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.