H.R. 1785 — Preventing Medicare Telefraud Act

This section requires, effective 180 days after enactment, an in-person service by the ordering physician or practitioner at least once in the prior six months as a condition of Medicare payment for high-cost durable medical equipment (DME) or high-cost laboratory tests ordered via telehealth (with the CMS Administrator to define and specify such high-cost items and tests); and directs Medicare administrative contractors, beginning six months after enactment, to periodically review claims and audit physicians or practitioners prescribing DME or laboratory tests where at least 90% of such prescriptions in the prior 12 months occurred via telehealth to verify coverage compliance. (DME, such as wheelchairs and oxygen equipment, is paid under a fee schedule at 80% of the lesser of the actual charge or the fee-schedule amount; laboratory tests are paid under the clinical laboratory fee schedule.)

This section requires physicians and practitioners to submit claims for separately billable telehealth services under Medicare Part B using their National Provider Identifier (NPI), prohibiting payment for such services furnished on or after 180 days after enactment unless the NPI is used.