Medicare Fraud Detection and Deterrence Act of 2023

Subjects: Health


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1745 Introduced in House (IH)]

&lt;DOC&gt;






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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Fraud Detection and 
Deterrence Act of 2023''.

SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, AND ABUSE PROVISIONS.

    (a) Deactivation of National Provider Identifier for Certain 
Excluded Entities.--Section 1173(b) of the Social Security Act (42 
U.S.C. 1320d-2(b)) is amended by adding at the end the following new 
paragraph:
            ``(3) Mandatory deactivation of certain identifiers.--
                    ``(A) In general.--Not later than 90 days after the 
                date of the enactment of this paragraph, the Secretary 
                shall revise the standards adopted under paragraph (1) 
                to provide for--
                            ``(i) the deactivation of a standard unique 
                        health identifier of entity type 1 (as defined 
                        for purposes of such standards) assigned to an 
                        entity if such entity is excluded from 
                        participation in any Federal health care 
                        program under section 1128 or 1128A;
                            ``(ii) the deactivation of a standard 
                        unique health identifier of entity type 2 (as 
                        defined for purposes of such standards) 
                        assigned to an entity if such entity is so 
                        excluded, but only if--
                                    ``(I) the Inspector General of the 
                                Department of Health and Human Services 
                                submits to the Secretary a request for 
                                such deactivation; and
                                    ``(II) the Secretary determines 
                                such deactivation to be appropriate; 
                                and
                            ``(iii) the reactivation of a standard 
                        unique health identifier deactivated pursuant 
                        to clause (i) or (ii) at the end of such 
                        deactivation (as described in subparagraph 
                        (B)).
                    ``(B) Term of deactivation.--A deactivation 
                described in subparagraph (A) made with respect to an 
                entity excluded from participation in any Federal 
                health care program under section 1128 or 1128A shall 
                begin on the date of such exclusion and shall end on 
                the date such exclusion is terminated.
                    ``(C) Nonapplication of deactivation.--
                Notwithstanding subparagraph (A), no deactivation of a 
                standard unique health identifier assigned to an entity 
                excluded from participation in any Federal health care 
                program under section 1128 or 1128A shall be made 
                pursuant to such subparagraph if the Secretary has 
                waived such exclusion with respect to any Federal 
                health care program pursuant to section 1128(c)(3)(B).
                    ``(D) Annual review of exclusion list.--Not later 
                than 1 year after the date of the enactment of this 
                paragraph and not less frequently than annually 
                thereafter, the Secretary shall compare the list of 
                individuals and entities excluded from participation in 
                any Federal health care program under section 1128 or 
                1128A maintained by the Inspector General of the 
                Department of Health and Human Services (or a successor 
                list) with a list of active standard unique health 
                identifiers described in subparagraph (A) to ensure 
                compliance with such subparagraph.''.
    (b) Medicare Advantage Plan Provision of National Provider 
Identifier for Certain Items and Services.--Section 1859 of the Social 
Security Act (42 U.S.C. 1395w-28) is amended by adding at the end the 
following new subsection:
    ``(j) Provision of National Provider Identifier for Certain Items 
and Services.--
            ``(1) In general.--In the case of any encounter data 
        submitted by a Medicare Advantage plan with respect to a 
        designated item or service furnished to an individual under 
        such plan on or after the date of the enactment of this 
        subsection, the Secretary shall require that such data include 
        the standard unique health identifier established pursuant to 
        standards described in section 1173(b) of the provider of 
        services or supplier that ordered such item or service or 
        referred such individual for such item or service.
            ``(2) Rejection of data.--The Secretary shall reject any 
        encounter data submitted by a Medicare Advantage plan if--
                    ``(A) such data does not comply with the 
                requirement described in paragraph (1); or
                    ``(B) the Secretary determines that a standard 
                unique health identifier included in such data in 
                accordance with such requirement is not active or is 
                otherwise invalid.
            ``(3) Definition of designated item or service.--For 
        purposes of this subsection, the term `designated item or 
        service' means any of the following:
                    ``(A) An item of durable medical equipment.
                    ``(B) A prosthetic or orthotic device.
                    ``(C) A clinical diagnostic laboratory test.
                    ``(D) A diagnostic imaging test (as specified by 
                the Secretary).
                    ``(E) A home health service (as specified by the 
                Secretary).''.
    (c) Identification of Relationships Between Telehealth Suppliers 
and Telehealth Companies Under Medicare.--Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the 
following new paragraph:
            ``(10) Identification of relationships between telehealth 
        suppliers and telehealth companies.--
                    ``(A) In general.--In the case of a telehealth 
                service furnished on or after the date of the enactment 
                of this paragraph by a specified entity, no payment may 
                be made under this section for such service unless the 
                claim for such service includes the modifier 
                established pursuant to subparagraph (B).
                    ``(B) Establishment of modifier.--Not later than 90 
                days after the date of the enactment of this paragraph, 
                the Secretary shall establish a claims modifier for 
                purposes of identifying telehealth services payable 
                under this section furnished by a specified entity (as 
                defined in subparagraph (C)).
                    ``(C) Definitions.--In this section:
                            ``(i) Specified entity.--The term 
                        `specified entity' means a physician or 
                        practitioner (as such terms are defined in 
                        paragraph (4)) that has an employment or other 
                        contractual relationship in effect with a 
                        telehealth company relating to the furnishing 
                        telehealth services.
                            ``(ii) Telehealth company.--The term 
                        `telehealth company' means an entity--
                                    ``(I) that employs or otherwise 
                                contracts with physicians or 
                                practitioners to furnish telehealth 
                                services; and
                                    ``(II) that does not employ or 
                                otherwise contract with any physician 
                                or practitioner to furnish items and 
                                services in-person (or that employs or 
                                otherwise contracts with physicians or 
                                practitioners to furnish such in-person 
                                items and services in a de minimis 
                                manner compared to the amount of 
                                telehealth services furnished by such 
                                physicians or practitioners, as 
                                specified by the Secretary).''.
                                 &lt;all&gt;
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