Bill · H.R. 1785· House(119-HR-1785)
Preventing Medicare Telefraud Act
- 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 Preventing Medicare Telefraud Act aims to amend title XVIII of the Social Security Act. It establishes new requirements for the provision of certain high-cost durable medical equipment and laboratory testing. The bill limits payments for these items if they are ordered via telehealth without a prior in-person service. It also mandates audits for providers who prescribe a high volume of these items through telehealth. Additionally, the bill requires the submission of a national provider identification number for separately billable telehealth services.
Yes· 3 of 4
Does this reduce what the federal government spends?+3
The bill reduces potential government spending by limiting payments for high-cost items ordered via telehealth without an in-person visit.
Would people over 65 be better off under this?+2
The bill may protect seniors from potential telehealth fraud regarding high-cost equipment and tests.
Would retired people be better off under this?+2
The bill aims to prevent fraud in the Medicare system used by retirees.
The opposite
Does this make health care easier to get in general?-4
The requirement for an in-person visit within 6 months could reduce healthcare access for those who rely primarily on telehealth.
Does this put more money into Medicare, the health coverage for people over 65?-2
The bill may reduce overall Medicare spending by imposing stricter requirements and audit processes for certain services.
Would households on low incomes be better off under this?-2
Low-income households who rely on telehealth may face new barriers to obtaining high-cost medical equipment or tests.
Who it would affect, and how
Potential Positive Impacts for People
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Increased Oversight of High-Cost Items: The bill implements a requirement that a physician or practitioner must have furnished an in-person service to an individual at least once during the 6 month period prior to ordering high-cost durable medical equipment (Section 2(a)(I)). This is intended to create standards for high-cost equipment.
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Enhanced Accountability for Laboratory Tests: Similar to medical equipment, the bill requires an in-person service to be provided within the 6 month period before a high-sost laboratory test is ordered via telehealth (Section 2(b)(6)(A)).
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Audit Procedures to Ensure Compliance: Medicare administrative contractors will conduct reviews and audits on providers who prescribe a high volume—at least 90 percent—of their items or tests through telehealth (Section 2(a)(vii) and Section 2(b)(7)). This is designed to determine if claims comply with coverage requirements.
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Standardized Billing for Telehealth: The bill requires practitioners to submit a claim for payment using their assigned national provider identification number for separately billable telehealth services (Section 3).
Potential Negative Impacts for People
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Payment Limitations Due to In-Person Requirements: Payment may be denied for high-cost durable medical equipment if the physician has not seen the patient in person within the previous 6 months (Section 2(a)(I)).
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Payment Limitations for Laboratory Tests: Payment may be denied for high-cost laboratory tests if the provider has not furnished an in-person service to the individual within a 6 month period (Section 2(b)(6)(A)).
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Increased Audit Frequency: Providers who prescribe a high volume of items or tests via telehealth—specifically 90 percent or more—will be subject to audits of all their claims to check for compliance (Section 2(a)(vii)(B) and Section 2(b)(7)(B)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Healthcare
- Improves Healthcare Access-4Increases Medicare Funding-2
- Economy And Finance
- Reduces Government Spending+3
- Demographic And Interest Groups
- Good For Retirees+2Good For Seniors+2Good For Low Income Households-2
- Governance And Ideology
- Improves Government Transparency+2
- 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