Bill > HR1745

This bill, the Medicare Fraud Detection and Deterrence Act of 2023, aims to strengthen provisions related to healthcare waste, fraud, and abuse. The key provisions are: 1. Mandatory deactivation of National Provider Identifiers (NPIs) assigned to entities excluded from participating in federal healthcare programs, with some exceptions. The Secretary of Health and Human Services (HHS) must review the exclusion list annually to ensure compliance. 2. Requirement for Medicare Advantage plans to include the NPI of the provider who ordered or referred certain items and services (e.g., durable medical equipment, laboratory tests) in their encounter data submissions. The Secretary can reject data that does not comply with this requirement. 3. Establishment of a claims modifier to identify telehealth services furnished by a "specified entity," which is a physician or practitioner that has an employment or contractual relationship with a "telehealth company" that primarily furnishes telehealth services rather than in-person care. This is intended to help monitor relationships between telehealth providers and companies. The overall purpose of the bill is to enhance the government's ability to detect and deter healthcare fraud, waste, and abuse within the Medicare program.