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 Com-
mittee 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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Fraud Detec-
tion and Deterrence Act of 2023’’. 
SEC. 2. STRENGTHENING HEALTH CARE WASTE, FRAUD, 
AND ABUSE PROVISIONS. 
(a) DEACTIVATION OF NATIONAL PROVIDER IDENTI-
FIER
FOR
CERTAIN
EXCLUDED
ENTITIES.—Section 
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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 stand-
ards 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) as-
signed to an entity if such entity is ex-
cluded 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) as-
signed to an entity if such entity is so ex-
cluded, but only if— 
‘‘(I) the Inspector General of the 
Department of Health and Human 
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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 pursu-
ant to clause (i) or (ii) at the end of such 
deactivation (as described in subparagraph 
(B)). 
‘‘(B) TERM OF DEACTIVATION.—A deacti-
vation described in subparagraph (A) made 
with respect to an entity excluded from partici-
pation 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
DEACTIVA-
TION.—Notwithstanding subparagraph (A), no 
deactivation of a standard unique health identi-
fier assigned to an entity excluded from partici-
pation 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 
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Federal health care program pursuant to sec-
tion 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 Sec-
retary shall compare the list of individuals and 
entities excluded from participation in any Fed-
eral 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 stand-
ard unique health identifiers described in sub-
paragraph (A) to ensure compliance with such 
subparagraph.’’. 
(b) MEDICARE ADVANTAGE PLAN PROVISION OF NA-
TIONAL 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 IDENTI-
FIER FOR CERTAIN ITEMS AND SERVICES.— 
‘‘(1) IN GENERAL.—In the case of any encoun-
ter data submitted by a Medicare Advantage plan 
with respect to a designated item or service fur-
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nished 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 pursu-
ant 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 Medi-
care 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 fol-
lowing: 
‘‘(A) An item of durable medical equip-
ment. 
‘‘(B) A prosthetic or orthotic device. 
‘‘(C) A clinical diagnostic laboratory test. 
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‘‘(D) A diagnostic imaging test (as speci-
fied 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 Secu-
rity Act (42 U.S.C. 1395m(m)) is amended by adding at 
the end the following new paragraph: 
‘‘(10) IDENTIFICATION OF RELATIONSHIPS BE-
TWEEN TELEHEALTH SUPPLIERS AND TELEHEALTH 
COMPANIES.— 
‘‘(A) IN GENERAL.—In the case of a tele-
health service furnished on or after the date of 
the enactment of this paragraph by a specified 
entity, no payment may be made under this sec-
tion for such service unless the claim for such 
service includes the modifier established pursu-
ant to subparagraph (B). 
‘‘(B) ESTABLISHMENT OF MODIFIER.—Not 
later than 90 days after the date of the enact-
ment of this paragraph, the Secretary shall es-
tablish a claims modifier for purposes of identi-
fying telehealth services payable under this sec-
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tion 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 fur-
nishing telehealth services. 
‘‘(ii) TELEHEALTH
COMPANY.—The 
term ‘telehealth company’ means an enti-
ty— 
‘‘(I) that employs or otherwise 
contracts with physicians or practi-
tioners 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 
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telehealth services furnished by such 
physicians or practitioners, as speci-
fied by the Secretary).’’. 
Æ 
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