Medicare Fraud Detection and Deterrence Act of 2025

This bill aims to cut Medicare waste, fraud, and abuse. It tells CMS to turn off the national provider numbers of health care providers who are barred from federal health programs because of bad behavior, and to turn them back on when the ban ends . It also tightens data rules for Medicare Advantage: plans must include the ordering or referring provider’s national provider identifier when they send data about certain items and services, like durable medical equipment, lab tests, imaging, and home health; data without a valid number will be rejected . For telehealth, clinicians who work for telehealth-only companies must add a special code to their Medicare claims, or Medicare will not pay the claim.

Key points

• Who is affected: Medicare providers and suppliers; Medicare Advantage plans; telehealth companies and their clinicians; Medicare patients who use these services .
• What changes: HHS/CMS must deactivate provider numbers for excluded providers and review exclusion lists each year; Medicare Advantage data must include the provider’s identifier for certain items/services; telehealth claims from telehealth-only companies must include a new claims modifier or won’t be paid .
• When: CMS must set the deactivation standard within 180 days; the Medicare Advantage data rule applies to services on or after enactment; the telehealth modifier must be in place within 180 days, and Medicare will require it for payment starting then; HHS must begin annual exclusion-list checks within one year of enactment .