Medicare Fraud Detection and Deterrence Act of 2025
Medicare Fraud Detection and Deterrence Act of 2025
Plain Language Summary
# Medicare Fraud Detection and Deterrence Act of 2025 - Summary **What the Bill Does** This bill aims to reduce fraud and waste in the Medicare program by making it harder for dishonest healthcare providers to operate. If passed, it would require Medicare to deactivate the identification numbers of providers who have been excluded from federal healthcare programs due to fraud, waste, or abuse—essentially removing them from the system. The bill also requires Medicare Advantage plans (private insurance plans that serve Medicare beneficiaries) to track providers using standardized identification numbers when billing for equipment, medical supplies, tests, and home health services. Additionally, telehealth companies would need to use special billing codes to identify which doctors are providing remote Medicare services. **Who It Affects and Current Status** The bill primarily affects Medicare beneficiaries (seniors and some disabled individuals), healthcare providers, Medicare Advantage insurance plans, and telehealth companies.
It targets fraudulent or negligent providers while creating better tracking mechanisms for legitimate ones. Currently, the bill is in committee, meaning it has been introduced but hasn't yet been debated or voted on by the full House of Representatives. The bill was sponsored by Representative Lloyd Doggett, a Democrat from Texas.
CRS Official Summary
Medicare Fraud Detection and Deterrence Act of 2025This bill requires the Centers for Medicare & Medicaid Services (CMS) to deactivate the standard unique health identifiers of health care providers that are excluded from federal health care programs because of fraud, waste, or abuse.The bill also requires (1) any data submitted by Medicare Advantage plans with respect to durable medical equipment, prosthetics or orthotics, laboratory tests, imaging tests, or home health services to include the standard unique health identifier of the associated provider or supplier; and (2) health care practitioners who are employed by or contract with telehealth companies to use a specialized claims modifier (developed by CMS) for Medicare telehealth services.
Latest Action
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.