I 

118TH CONGRESS 

1ST SESSION H. R. 1746 

To amend title XVIII of the Social Security Act to establish requirements 

for the provision of certain high-cost durable medical equipment and 

laboratory testing, and for other purposes. 

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 title XVIII of the Social Security Act to establish 

requirements for the provision of certain high-cost durable medical equipment and laboratory testing, and for 

other purposes. 

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 ‘‘Preventing Medicare 

5 Telefraud Act’’. 


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1 SEC. 2. REQUIREMENT FOR PROVISION OF HIGH-COST DU2 RABLE MEDICAL EQUIPMENT AND LABORA3 TORY TESTS. 

4 (a) HIGH-COST DURABLE MEDICAL EQUIPMENT.— 

5 Section 1834(a)(1)(E) of the Social Security Act (42 

6 U.S.C. 1395m(a)(1)(E)) is amended by adding at the end 

7 the following new clause: 

8 ‘‘(vi) STANDARDS FOR HIGH-COST DU9 RABLE MEDICAL EQUIPMENT.— 

10 ‘‘(I) LIMITATION ON PAYMENT

11 FOR HIGH-COST DURABLE MEDICAL

12 EQUIPMENT.—Payment may not be 

13 made under this subsection for a 

14 high-cost durable medical equipment 

15 ordered by a physician or other practi16 tioner described in clause (ii) via tele17 health for an individual, unless such 

18 physician or practitioner furnished to 

19 such individual a service in-person at 

20 least once during the 6-month period 

21 prior to ordering such high-cost dura22 ble medical equipment. 

23 ‘‘(II) HIGH-COST DURABLE MED24 ICAL EQUIPMENT DETERMINATION.— 

25 For purposes of this clause, the Ad26 ministrator of the Centers for MediVerDate Sep 11 2014 02:31 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1746.IH H1746

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1 care & Medicaid Services shall define 

2 the term ‘high-cost durable medical 

3 equipment’ and specify the durable 

4 medical equipment for which such def5 inition shall apply. 

6 ‘‘(vii) AUDIT OF PROVIDERS AND

7 PRACTITIONERS FURNISHING A HIGH VOL8 UME OF DURABLE MEDICAL EQUIPMENT

9 VIA TELEHEALTH.— 

10 ‘‘(I) IDENTIFICATION OF PRO11 VIDERS.—Beginning 6 months after 

12 the effective date of this clause, Medi13 care administrative contractors shall 

14 conduct reviews on a schedule deter15 mined by the Secretary, of claims for 

16 durable medical equipment prescribed 

17 by a physician or other practitioner 

18 described in clause (ii) during the 12- 

19 month period preceding such review to 

20 identify physicians or other practi21 tioners with respect to whom at least 

22 90 percent of all durable medical 

23 equipment prescribed by such physi24 cian or practitioner during such peVerDate Sep 11 2014 02:31 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1746.IH H1746

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1 riod was prescribed pursuant to a 

2 telehealth visit. 

3 ‘‘(II) AUDIT.—In the case of a 

4 physician or practitioner identified 

5 under subclause (I), with respect to a 

6 period described in such subclause, 

7 the Medicare administrative contrac8 tors shall conduct audits of all claims 

9 for durable medical equipment pre10 scribed by such physicians or practi11 tioners to determine whether such 

12 claims comply with the requirements 

13 for coverage under this title.’’. 

14 (b) HIGH-COST LABORATORY TESTS.—Section 

15 1834A(b) of the Social Security Act (42 U.S.C. 1395m– 

16 1(b)) is amended by adding at the end the following new 

17 paragraph: 

18 ‘‘(6) REQUIREMENT FOR HIGH-COST LABORA19 TORY TESTS.— 

20 ‘‘(A) LIMITATION ON PAYMENT FOR HIGH21 COST LABORATORY TESTS.—Payment may not 

22 be made under this subsection for a high-cost 

23 laboratory test ordered by a physician or practi24 tioner via telehealth for an individual, unless 

25 such physician or practitioner furnished to such 


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1 individual a service in-person at least once dur2 ing the 6-month period prior to ordering such 

3 high-cost laboratory test. 

4 ‘‘(B) HIGH-COST LABORATORY TEST DE5 FINED.—For purposes of this paragraph, the 

6 Administrator for the Centers for Medicare & 

7 Medicaid Services shall define the term ‘high8 cost laboratory test’ and specify which labora9 tory tests such definition shall apply to. 

10 ‘‘(7) AUDIT OF LABORATORY TESTING OR11 DERED PURSUANT TO TELEHEALTH VISIT.— 

12 ‘‘(A) IDENTIFICATION OF PROVIDERS.— 

13 Beginning 6 months after the effective date of 

14 this paragraph, Medicare administrative con15 tractors shall conduct periodic reviews on a 

16 schedule determined by the Secretary, of claims 

17 for laboratory tests prescribed by a physician or 

18 practitioner during the 12-month period pre19 ceding such review to identify physicians or 

20 other practitioners with respect to whom at 

21 least 90 percent of all laboratory tests pre22 scribed by such physician or practitioner during 

23 such period was prescribed pursuant to a tele24 health visit. 


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1 ‘‘(B) AUDIT.—In the case of a physician 

2 or practitioner identified under subparagraph 

3 (A), with respect to a period described in such 

4 subparagraph, the Medicare administrative con5 tractors shall conduct audits of all claims for 

6 laboratory tests prescribed by such physicians 

7 or practitioners during such period beginning to 

8 determine whether such claims comply with the 

9 requirements for coverage under this title.’’. 

10 (c) EFFECTIVE DATE.—The amendments made by 

11 this section shall take effect upon the termination of the 

12 emergency period described in section 1135(g)(1)(B) of 

13 the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 

14 SEC. 3. REQUIREMENT TO SUBMIT NPI NUMBER FOR SEPA15 RATELY BILLABLE TELEHEALTH SERVICES. 

16 (a) REQUIREMENT TO SUBMIT NPI NUMBER FOR

17 SEPARATELY BILLABLE TELEHEALTH SERVICES.—Sec18 tion 1834(m) of the Social Security Act (42 U.S.C. 

19 1395m(m)) is amended by adding at the end the following 

20 new paragraph: 

21 ‘‘(10) REQUIREMENT TO SUBMIT NPI NUMBER

22 FOR SEPARATELY BILLABLE TELEHEALTH SERV23 ICES.—Payment may not be made under this sub24 section for separately billable telehealth services fur25 nished by a physician or practitioner unless such 


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1 physician or practitioner submits a claim for pay2 ment under the national provider identification num3 ber assigned to such physician or practitioner.’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 this section shall take effect upon the termination of the 

6 emergency period described in section 1135(g)(1)(B) of 

7 the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)). 

Æ 


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