H.R.1785 - Preventing Medicare Telefraud Act (119th Congress)
Summary
H.R.1785, the Preventing Medicare Telefraud Act, aims to amend Title XVIII of the Social Security Act to establish stricter requirements for the provision of high-cost durable medical equipment and laboratory testing via telehealth. The bill mandates in-person service prior to ordering high-cost items or tests and requires NPI number submission for telehealth services. It also directs audits of providers with high telehealth prescription rates.
Expected Effects
This bill will likely reduce fraudulent claims and improper payments within Medicare related to telehealth services. It will also increase the administrative burden on providers and potentially limit access to telehealth for some beneficiaries. The intended effect is to safeguard Medicare funds and ensure appropriate utilization of telehealth.
Potential Benefits
- Reduces potential for fraudulent claims and improper payments in Medicare.
- Ensures a baseline level of in-person care before high-cost services are rendered via telehealth.
- Promotes responsible use of telehealth services.
- Enhances oversight and accountability of providers offering telehealth services.
- May lead to better patient outcomes by requiring in-person evaluation.
Most Benefited Areas:
Potential Disadvantages
- May limit access to telehealth services, especially for beneficiaries in rural or underserved areas.
- Increases administrative burden on healthcare providers.
- Could delay necessary medical care due to the in-person visit requirement.
- May disproportionately affect beneficiaries who rely on telehealth for convenience or cost savings.
- Potential for increased costs for beneficiaries who must now travel for in-person visits.
Constitutional Alignment
The bill aligns with the general welfare clause of the Constitution (Preamble), as it aims to protect Medicare funds and ensure appropriate healthcare delivery. Congress has the power to legislate on matters related to healthcare under the Necessary and Proper Clause (Article I, Section 8) to execute its powers to collect taxes and provide for the general welfare. The bill does not appear to infringe on any specific constitutional rights or freedoms.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).