PlainBillCongress, translated.Legislation. Context. Public interest.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.
Congressional Research Service
Version 00 · Introduced in House · Mar 3, 2025
Preventing Medicare Telefraud Act
This bill establishes conditions for payment of certain telehealth services, laboratory tests, and durable medical equipment under Medicare.
Specifically, the bill conditions payment for certain high-cost laboratory tests and durable medical equipment that are ordered via telehealth on at least one in-person visit during the preceding six-month period. Additionally, practitioners must submit claims for separately billable telehealth services under the practitioner's unique national provider identification number.
People & committees
Rep. Doggett, Lloyd [D-TX-37] · D–TX
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
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.
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.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Mar 27, 2025. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-03-03 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This bill proposes new Medicare payment conditions for high-cost medical equipment and laboratory tests ordered through telehealth, meaning remote medical visits. The ordering clinician would need to have seen the patient in person within the previous six months. It would also require audits of equipment and test claims from clinicians who order predominantly through telehealth, and require clinicians billing separately for telehealth services to use their own provider identification numbers.
unless such physician or practitioner furnished to such individual a service in-person at least once during the 6 month period prior to ordering such high-cost durable medical equipment.
unless such physician or practitioner furnished to such individual a service in-person at least once during the 6 month period prior to ordering such high-cost laboratory test.
Audit of providers and practitioners furnishing a high volume of durable medical equipment via telehealth
Audit of laboratory testing ordered pursuant to telehealth visit
unless such physician or practitioner submits a claim for payment under the national provider identification number assigned to such physician or practitioner.
Section 1 would name the legislation the Preventing Medicare Telefraud Act.
This Act may be cited as the Preventing Medicare Telefraud Act.
For high-cost durable medical equipment ordered through telehealth starting 180 days after enactment, section 2 would prohibit payment under the amended subsection unless the ordering physician or practitioner had provided the patient an in-person service at least once in the preceding six months. This provision applies to physicians and practitioners referenced in an existing statutory clause that is not reproduced in the bundle.
Payment may not be made under this subsection for a high-cost durable medical equipment ordered by a physician or other practitioner described in clause (ii) via telehealth for an individual on or after the date that is 180 days after the date of the enactment of this clause, unless such physician or practitioner furnished to such individual a service in-person at least once during the 6 month period prior to ordering such high-cost durable medical equipment.
For high-cost laboratory tests ordered through telehealth starting 180 days after enactment, section 2 would likewise prohibit payment under the amended subsection unless the ordering physician or practitioner had provided the patient an in-person service at least once in the preceding six months.
Payment may not be made under this subsection for a high-cost laboratory test ordered by a physician or practitioner via telehealth for an individual on or after the date that is 180 days after the date of the enactment of this paragraph, unless such physician or practitioner furnished to such individual a service in-person at least once during the 6 month period prior to ordering such high-cost laboratory test.
The Administrator of the Centers for Medicare & Medicaid Services would have to define which durable medical equipment and laboratory tests count as high-cost and specify the items covered by those definitions. The bill itself does not set a dollar threshold.
the Administrator of the Centers for Medicare & Medicaid Services shall define the term high-cost durable medical equipment and specify the durable medical equipment for which such definition shall apply.
the Administrator for the Centers for Medicare & Medicaid Services shall define the term high-cost laboratory test and specify which laboratory tests such definition shall apply to.
Beginning six months after enactment, Medicare administrative contractors would review equipment claims on a schedule set by the Secretary. They would identify clinicians for whom at least 90 percent of durable medical equipment prescribed during the preceding 12 months was prescribed through telehealth. Those clinicians' equipment claims would then be audited for compliance with Medicare coverage requirements. The audit language covers durable medical equipment generally, without limiting it to high-cost equipment.
Beginning 6 months after the date of the enactment of this clause, Medicare administrative contractors shall conduct reviews on a schedule determined by the Secretary, of claims for durable medical equipment prescribed by a physician or other practitioner described in clause (ii) during the 12 month period preceding such review to identify physicians or other practitioners with respect to whom at least 90 percent of all durable medical equipment prescribed by such physician or practitioner during such period was prescribed pursuant to a telehealth visit.
In the case of a physician or practitioner identified under subclause (I), with respect to a period described in such subclause, the Medicare administrative contractors shall conduct audits of all claims for durable medical equipment prescribed by such physicians or practitioners to determine whether such claims comply with the requirements for coverage under this title.
Beginning six months after enactment, Medicare administrative contractors would also review laboratory claims on a schedule set by the Secretary. They would identify clinicians for whom at least 90 percent of laboratory tests prescribed during the preceding 12 months were prescribed through telehealth, then audit all laboratory-test claims prescribed by those clinicians during that period for coverage compliance. This audit requirement is not limited to high-cost tests.
Beginning 6 months after the date of the enactment of this paragraph, Medicare administrative contractors shall conduct periodic reviews on a schedule determined by the Secretary, of claims for laboratory tests prescribed by a physician or practitioner during the 12 month period preceding such review to identify physicians or other practitioners with respect to whom at least 90 percent of all laboratory tests prescribed by such physician or practitioner during such period was prescribed pursuant to a telehealth visit.
In the case of a physician or practitioner identified under subparagraph (A), with respect to a period described in such subparagraph, the Medicare administrative contractors shall conduct audits of all claims for laboratory tests prescribed by such physicians or practitioners during such period beginning to determine whether such claims comply with the requirements for coverage under this title.
Section 3 would prohibit payment under the amended telehealth subsection for separately billable services furnished starting 180 days after enactment unless the physician or practitioner submits the payment claim using the national provider identification number assigned to that clinician.
Payment may not be made under this subsection for separately billable telehealth services furnished on or after the date that is 180 days after the date of the enactment of this paragraph by a physician or practitioner unless such physician or practitioner submits a claim for payment under the national provider identification number assigned to such physician or practitioner.
The supplied official-actions snapshot, updated March 27, 2025, records introduction in the House on March 3, 2025, and referral that day to the Energy and Commerce and Ways and Means committees for provisions within their respective jurisdictions. This snapshot does not establish subsequent action or enactment.
Source snapshot updated 2025-03-27T15:12:11Z.
2025-03-03: Introduced in House
2025-03-03: 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 closer look
Reviewed version: Introduced in House · 2025-03-03. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish what appears in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places was identified in the complete supplied introduced text. This conclusion is limited to that version; formal earmark status in accompanying materials cannot be assessed.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential benefit, special exemption, or carve-out was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Mar 27, 2025. How PlainBill uses AI