I 

118TH CONGRESS 

1ST SESSION H. R. 1745 

To amend titles XI and XVIII of the Social Security Act to strengthen 

health care waste, fraud, and abuse provisions. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 23, 2023 

Mr. DOGGETT introduced the following bill; which was 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 

A BILL 

To amend titles XI and XVIII of the Social Security Act 

to strengthen health care waste, fraud, and abuse provisions. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Fraud Detec5 tion and Deterrence Act of 2023’’. 

6 SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, 

7 AND ABUSE PROVISIONS. 

8 (a) DEACTIVATION OF NATIONAL PROVIDER IDENTI9 FIER FOR CERTAIN EXCLUDED ENTITIES.—Section 


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1 1173(b) of the Social Security Act (42 U.S.C. 1320d– 

2 2(b)) is amended by adding at the end the following new 

3 paragraph: 

4 ‘‘(3) MANDATORY DEACTIVATION OF CERTAIN

5 IDENTIFIERS.— 

6 ‘‘(A) IN GENERAL.—Not later than 90 

7 days after the date of the enactment of this 

8 paragraph, the Secretary shall revise the stand9 ards adopted under paragraph (1) to provide 

10 for— 

11 ‘‘(i) the deactivation of a standard 

12 unique health identifier of entity type 1 (as 

13 defined for purposes of such standards) as14 signed to an entity if such entity is ex15 cluded from participation in any Federal 

16 health care program under section 1128 or 

17 1128A; 

18 ‘‘(ii) the deactivation of a standard 

19 unique health identifier of entity type 2 (as 

20 defined for purposes of such standards) as21 signed to an entity if such entity is so ex22 cluded, but only if— 

23 ‘‘(I) the Inspector General of the 

24 Department of Health and Human 


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1 Services submits to the Secretary a 

2 request for such deactivation; and 

3 ‘‘(II) the Secretary determines 

4 such deactivation to be appropriate; 

5 and 

6 ‘‘(iii) the reactivation of a standard 

7 unique health identifier deactivated pursu8 ant to clause (i) or (ii) at the end of such 

9 deactivation (as described in subparagraph 

10 (B)). 

11 ‘‘(B) TERM OF DEACTIVATION.—A deacti12 vation described in subparagraph (A) made 

13 with respect to an entity excluded from partici14 pation in any Federal health care program 

15 under section 1128 or 1128A shall begin on the 

16 date of such exclusion and shall end on the date 

17 such exclusion is terminated. 

18 ‘‘(C) NONAPPLICATION OF DEACTIVA19 TION.—Notwithstanding subparagraph (A), no 

20 deactivation of a standard unique health identi21 fier assigned to an entity excluded from partici22 pation in any Federal health care program 

23 under section 1128 or 1128A shall be made 

24 pursuant to such subparagraph if the Secretary 

25 has waived such exclusion with respect to any 


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1 Federal health care program pursuant to sec2 tion 1128(c)(3)(B). 

3 ‘‘(D) ANNUAL REVIEW OF EXCLUSION

4 LIST.—Not later than 1 year after the date of 

5 the enactment of this paragraph and not less 

6 frequently than annually thereafter, the Sec7 retary shall compare the list of individuals and 

8 entities excluded from participation in any Fed9 eral health care program under section 1128 or 

10 1128A maintained by the Inspector General of 

11 the Department of Health and Human Services 

12 (or a successor list) with a list of active stand13 ard unique health identifiers described in sub14 paragraph (A) to ensure compliance with such 

15 subparagraph.’’. 

16 (b) MEDICARE ADVANTAGE PLAN PROVISION OF NA17 TIONAL PROVIDER IDENTIFIER FOR CERTAIN ITEMS AND

18 SERVICES.—Section 1859 of the Social Security Act (42 

19 U.S.C. 1395w–28) is amended by adding at the end the 

20 following new subsection: 

21 ‘‘(j) PROVISION OF NATIONAL PROVIDER IDENTI22 FIER FOR CERTAIN ITEMS AND SERVICES.— 

23 ‘‘(1) IN GENERAL.—In the case of any encoun24 ter data submitted by a Medicare Advantage plan 

25 with respect to a designated item or service furVerDate Sep 11 2014 03:51 Apr 06, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1745.IH H1745

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1 nished to an individual under such plan on or after 

2 the date of the enactment of this subsection, the 

3 Secretary shall require that such data include the 

4 standard unique health identifier established pursu5 ant to standards described in section 1173(b) of the 

6 provider of services or supplier that ordered such 

7 item or service or referred such individual for such 

8 item or service. 

9 ‘‘(2) REJECTION OF DATA.—The Secretary 

10 shall reject any encounter data submitted by a Medi11 care Advantage plan if— 

12 ‘‘(A) such data does not comply with the 

13 requirement described in paragraph (1); or 

14 ‘‘(B) the Secretary determines that a 

15 standard unique health identifier included in 

16 such data in accordance with such requirement 

17 is not active or is otherwise invalid. 

18 ‘‘(3) DEFINITION OF DESIGNATED ITEM OR

19 SERVICE.—For purposes of this subsection, the term 

20 ‘designated item or service’ means any of the fol21 lowing: 

22 ‘‘(A) An item of durable medical equip23 ment. 

24 ‘‘(B) A prosthetic or orthotic device. 

25 ‘‘(C) A clinical diagnostic laboratory test. 


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1 ‘‘(D) A diagnostic imaging test (as speci2 fied by the Secretary). 

3 ‘‘(E) A home health service (as specified 

4 by the Secretary).’’. 

5 (c) IDENTIFICATION OF RELATIONSHIPS BETWEEN

6 TELEHEALTH SUPPLIERS AND TELEHEALTH COMPANIES

7 UNDER MEDICARE.—Section 1834(m) of the Social Secu8 rity Act (42 U.S.C. 1395m(m)) is amended by adding at 

9 the end the following new paragraph: 

10 ‘‘(10) IDENTIFICATION OF RELATIONSHIPS BE11 TWEEN TELEHEALTH SUPPLIERS AND TELEHEALTH

12 COMPANIES.— 

13 ‘‘(A) IN GENERAL.—In the case of a tele14 health service furnished on or after the date of 

15 the enactment of this paragraph by a specified 

16 entity, no payment may be made under this sec17 tion for such service unless the claim for such 

18 service includes the modifier established pursu19 ant to subparagraph (B). 

20 ‘‘(B) ESTABLISHMENT OF MODIFIER.—Not 

21 later than 90 days after the date of the enact22 ment of this paragraph, the Secretary shall es23 tablish a claims modifier for purposes of identi24 fying telehealth services payable under this secVerDate Sep 11 2014 03:51 Apr 06, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1745.IH H1745

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1 tion furnished by a specified entity (as defined 

2 in subparagraph (C)). 

3 ‘‘(C) DEFINITIONS.—In this section: 

4 ‘‘(i) SPECIFIED ENTITY.—The term 

5 ‘specified entity’ means a physician or 

6 practitioner (as such terms are defined in 

7 paragraph (4)) that has an employment or 

8 other contractual relationship in effect with 

9 a telehealth company relating to the fur10 nishing telehealth services. 

11 ‘‘(ii) TELEHEALTH COMPANY.—The 

12 term ‘telehealth company’ means an enti13 ty— 

14 ‘‘(I) that employs or otherwise 

15 contracts with physicians or practi16 tioners to furnish telehealth services; 

17 and 

18 ‘‘(II) that does not employ or 

19 otherwise contract with any physician 

20 or practitioner to furnish items and 

21 services in-person (or that employs or 

22 otherwise contracts with physicians or 

23 practitioners to furnish such in-person 

24 items and services in a de minimis 

25 manner compared to the amount of 


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1 telehealth services furnished by such 

2 physicians or practitioners, as speci3 fied by the Secretary).’’. 

Æ 


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