Preventing Medicare Telefraud Act

This bill aims to cut down on Medicare fraud tied to telehealth. It says Medicare will only pay for certain expensive lab tests and medical equipment ordered by telehealth if the patient saw the doctor in person at least once in the past six months. What counts as “high-cost” will be defined by Medicare’s agency.

It also requires doctors and other clinicians to file telehealth claims using their own National Provider Identifier (NPI), which is their unique ID number. Medicare’s contractors must review and audit providers who order almost all of their tests or equipment through telehealth.

• Who is affected: Medicare patients using telehealth; doctors and other clinicians who order lab tests or medical equipment; Medicare contractors.
• What changes: An in-person visit within six months is required before Medicare pays for certain high-cost lab tests or equipment ordered by telehealth; telehealth claims must use the clinician’s own NPI; targeted reviews and audits will check high telehealth prescribers.
• When: These rules start six months after the bill becomes law.