HB1785, titled the Preventing Medicare Telefraud Act, would amend Medicare payment rules to add new safeguards for certain telehealth-related claims. The bill targets two categories of services that it treats as higher-risk for fraud or abuse: high-cost durable medical equipment and high-cost laboratory tests. For both categories, Medicare payment would generally be barred when the item or test is ordered through telehealth unless the ordering physician or practitioner had seen the patient in person at least once during the prior six months.
The bill also directs the Centers for Medicare & Medicaid Services to define which durable medical equipment and laboratory tests count as “high-cost” and to specify the items covered by those definitions. In addition, Medicare administrative contractors would be required to review claims and audit providers or practitioners whose prescribing patterns are overwhelmingly telehealth-based, using a 90-percent threshold over a 12-month lookback period. Separately, the bill requires that claims for separately billable telehealth services be submitted under the ordering clinician’s National Provider Identifier (NPI), rather than through another identifier.
Impact
If enacted, the bill would amend sections 1834(a), 1834A, and 1834(m) of the Social Security Act, tightening Medicare coverage and billing rules for telehealth-ordered durable medical equipment, laboratory tests, and separately billable telehealth services. It would give CMS authority to define the scope of “high-cost” equipment and tests, while also expanding the role of Medicare administrative contractors in identifying and auditing providers with unusually high telehealth prescribing patterns. The practical effect would be to impose new documentation, in-person visit, and claims-submission requirements on physicians, practitioners, suppliers, and laboratories participating in Medicare.
Sentiment
Based on the bill text and available context, the measure appears to be framed as an anti-fraud and program-integrity bill rather than a broad telehealth expansion or restriction. The title and structure suggest support for tighter oversight of Medicare billing, especially where telehealth may be used to facilitate questionable orders for expensive equipment or tests. No committee transcript or vote record is available here, so there is no documented floor or committee sentiment beyond the bill’s apparent intent to curb abuse.
Contention
The main point of contention is likely the bill’s restriction on telehealth-based ordering of high-cost durable medical equipment and laboratory tests, because it could limit access for legitimate patients who rely on telehealth and may create additional in-person visit requirements. Providers, telehealth advocates, and some patient groups may view the 6-month in-person prerequisite and audit triggers as burdensome or overly broad, while supporters are likely to argue that the measures are necessary to prevent Medicare fraud and improper billing. Another possible issue is the breadth of CMS’s discretion to define what counts as “high-cost,” which could affect how widely the new limits apply.
Requires Medicaid coverage for community violence prevention services; establishes training and certification program for violence prevention professionals.
Requires Medicaid coverage for community violence prevention services; establishes training and certification program for violence prevention professionals.