H.R. 1784 — Medicare Fraud Detection and Deterrence Act of 2025

This section strengthens Medicare waste, fraud, and abuse controls related to the National Provider Identifier (NPI), the standard unique health identifier for HIPAA-covered health care providers and suppliers (42 U.S.C. 1320d–2). Specifically, it (1) directs the Secretary of Health and Human Services, not later than 180 days after enactment, to revise HIPAA identifier standards to deactivate NPIs for entities excluded from federal health care programs under SSA §§1128 or 1128A—for entity type 1 (providers) automatically and for entity type 2 upon HHS Inspector General request and Secretary determination—with reactivation upon exclusion termination (except if waived under §1128(c)(3)(B)); and requires annual comparison of the exclusion list against active NPIs; (2) requires Medicare Advantage plans' encounter data submissions for designated items and services (i.e., durable medical equipment, prosthetics or orthotics, clinical diagnostic lab tests, diagnostic imaging tests, and home health services furnished on or after enactment) to include the NPI of the ordering or referring provider or supplier, with rejection of data lacking a valid, active NPI; and (3) prohibits Medicare payment for telehealth services furnished on or after 180 days post-enactment by a physician or practitioner with an employment or contractual relationship with a telehealth company (i.e., an entity that primarily employs or contracts for telehealth rather than in-person services) unless the claim includes a modifier established by the Secretary not later than 180 days after enactment.