Bill · H.R. 1784· House(119-HR-1784)
Medicare Fraud Detection and Deterrence Act of 2025
- Introduced
- 3/3/2025
- Last activity
- 3/3/2025 — 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.
- Sponsored by
- Lloyd Doggett
- Cosponsors
- None
- Introduced
- In Committee
What this bill would do
The Medicare Fraud Detection and Deterrence Act of 2025 aims to strengthen provisions against health care waste, fraud, and abuse. It requires the deactivation of unique health identifiers for entities excluded from Federal health care programs. The bill also mandates that Medicare Advantage plans include provider identifiers for certain items and services in their encounter data. Furthermore, it requires a specific modifier on claims for telehealth services provided by certain entities. These changes are intended to enhance oversight of providers and telehealth companies.
Yes· 3 of 6
Does this make what the government does easier for the public to see?+4
The bill increases transparency by requiring more detailed provider identification in Medicare Advantage encounter data and telehealth claims.
Would people over 65 be better off under this?+3
The bill protects Medicare resources from fraud and abuse, which benefits the senior population relying on these services.
Does this reduce what the federal government spends?+3
The bill strengthens oversight and detection of fraud and abuse in Medicare, which can lead to savings in federal healthcare spending.
The opposite
Does this make health care easier to get in general?-1
The new administrative requirements for telehealth modifiers and Medicare Advantage data may create new barriers to service provision.
Who it would affect, and how
Potential Positive Impacts for People
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Improved Oversight of Excluded Entities: By mandating the deactivation of unique health identifiers for entities excluded from Federal health care programs, the bill helps ensure that those who are barred from participation cannot easily operate under their previous identifiers. Section 2(a).
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Enhanced Data Accuracy for Medicare Advantage: The bill requires Medicare Advantage plans to include the unique health identifier of the provider who ordered or referred a designated item or service, which helps track specific services like durable medical equipment or diagnostic tests. Section 2(b).
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Better Identification of Telehealth Relationships: The requirement for a specific modifier on telehealth claims helps identify services provided by entities that have a relationship with telehealth companies, providing more transparency in how those services are furnished. Section 2(c).
Potential Negative Impacts for People
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Data Rejection for Medicare Advantage Plans: The Secretary is directed to reject encounter data from Medicare Advantage plans if it does not include the required provider identifier or if the identifier provided is inactive or invalid. Section 2(b).
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Payment Restrictions for Telehealth Services: No payment may be made for certain telehealth services unless the claim includes a specific modifier established by the Secretary, which could impact the payment process for specified entities. Section 2(c).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Demographic And Interest Groups
- Good For Seniors+3Good For Low Income Households+2Good For Veterans+2
- Governance And Ideology
- Improves Government Transparency+4
- Economy And Finance
- Reduces Government Spending+3
- Healthcare
- Increases Medicare Funding+2Improves Healthcare Access-1
- 3/3/2025
- 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.
- Introduced in House