I 

109TH CONGRESS 

1ST SESSION H. R. 4645 

To amend title XVIII of the Social Security Act to provide broader and 

more informed protection to Medicare eligible individuals from abusive 

marketing practices of Medicare prescription drug plans and MA–PD 

plans to permit enrollees under Medicare prescription drug plans that 

have been sanctioned to elect to enroll under other plans. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 18, 2005 

Ms. SCHWARTZ of Pennsylvania (for herself and Mrs. LOWEY) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

broader and more informed protection to Medicare eligible individuals from abusive marketing practices of Medicare prescription drug plans and MA–PD plans to permit 

enrollees under Medicare prescription drug plans that 

have been sanctioned to elect to enroll under other plans. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Preventing Medicare 

3 Seniors from being Confused due to Abusive Marketing 

4 (Prevent Medicare SCAMs) Act of 2005’’. 

5 SEC. 2. STRICTER PENALTIES FOR MA–PD PLANS AND 

6 MEDICARE PRESCRIPTION DRUG PLANS 

7 THAT VIOLATE MARKETING REQUIREMENTS. 

8 Section 1857(g) of the Social Security Act (42 U.S.C. 

9 1395w–27(g)) is amended by adding at the end the fol10 lowing new paragraph: 

11 ‘‘(5) DETERMINATIONS RELATED TO VIOLA12 TIONS OF MARKETING REQUIREMENTS OF MA–PD

13 PLANS AND PRESCRIPTION DRUG PLANS.—For pur14 poses of paragraphs (2) and (3), in the case that the 

15 Secretary makes a determination under paragraph 

16 (1)(E)(ii) or subsection (c)(2) because an MA–PD 

17 plan under this part or a prescription drug plan 

18 under part D is in violation of an applicable require19 ment relating to marketing and such a violation in20 volves mail, phone calls, emails, or pieces of other 

21 marketing material or communication specified by 

22 the Secretary, each piece of mail, each phone call, 

23 each email, and each piece of other marketing mate24 rial or communication involved shall represent a sep25 arate determination of such a violation.’’. 
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1 SEC. 3. PUBLIC NOTIFICATION OF MEDICARE PRESCRIP2 TION DRUG PLANS AND MA–PD PLANS THAT 

3 HABITUALLY RECEIVE INTERMEDIATE SANC4 TIONS. 

5 Section 1860D–4(a) of such Act (42 U.S.C. 13953– 

6 104(a)) is amended by adding at the end the following 

7 new paragraph: 

8 ‘‘(5) PUBLIC NOTIFICATION OF MEDICARE PRE9 SCRIPTION DRUG PLANS AND MA–PD PLANS WITH

10 HABITUAL VIOLATIONS.— 

11 ‘‘(A) IN GENERAL.—For 2008 and each 

12 succeeding year, not later than the notice and 

13 posting date described in subparagraph (C) for 

14 such a year, the Secretary shall— 

15 ‘‘(i) provide written notice to each 

16 part D eligible individual of the prescrip17 tion drug habitual sanctions information 

18 described in subparagraph (B); and 

19 ‘‘(ii) post such information on the of20 ficial public Internet site of the Depart21 ment of Health and Human Services and 

22 the official public Internet site of the Cen23 ters of Medicare & Medicaid Services. 

24 ‘‘(B) PRESCRIPTION DRUG HABITUAL

25 SANCTIONS INFORMATION.—For purposes of 

26 subparagraph (A), the prescription drug habit-
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1 ual sanctions information described in this sub2 paragraph for a year is the following: 

3 ‘‘(i) The name of— 

4 ‘‘(I) each prescription drug plan 

5 under this part to which the Secretary 

6 applied at least three sanctions under 

7 section 1857(g), as applied under sec8 tion 1860D–12(b)(3)(E), during any 

9 24-month period that preceeds the ap10 plicable notice and posting date for 

11 such year; and 

12 ‘‘(II) each MA–PD plan under 

13 part C to which the Secretary applied 

14 at least three sanctions under section 

15 1857(g) during such 24-month period. 

16 ‘‘(ii) For each plan described in clause 

17 (i), a description of the date and type of 

18 violation for each sanction described in 

19 such clause. 

20 ‘‘(C) NOTICE AND POSTING DATE.—For 

21 purposes of this paragraph, the notice and post22 ing date described in this subparagraph for 

23 2008 and each succeeding year is the first day 

24 of the annual, coordinated election period under 

25 section 1851(e)(3)(B)(iv) for such year.’’. 
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1 SEC. 4. PERMITTING MEDICARE BENEFICIARIES EN2 ROLLED UNDER SANCTIONED PRESCRIPTION 

3 DRUG PLANS TO ENROLL UNDER OTHER 

4 PLANS. 

5 Section 1860D–1(b)(3) of the Social Security Act (42 

6 U.S.C. 1395w–101(b)(3)) is amended by adding at the 

7 end the following new subparagraph: 

8 ‘‘(F) ENROLLMENT UNDER SANCTIONED PRE9 SCRIPTION DRUG PLAN.—In the case of a part D eli10 gible individual who is enrolled in a prescription 

11 drug plan, if enrollment in the plan is suspended 

12 under section 1857(g)(3)(C), as applied under sec13 tion 1860D–12(b)(3)(E), because of a failure of the 

14 plan to meet applicable requirements relating to 

15 marketing or provision of services, the special enroll16 ment period shall be the period of such suspension 

17 of enrollment.’’. 

18 SEC. 5. GAO STUDY ON ANTI-FRAUD AND ABUSE PROVI19 SIONS AND SANCTIONS FOR MEDICARE PRE20 SCRIPTION DRUG BENEFIT AND UNDER MA–

21 PD PLANS. 

22 (a) STUDY.—Not later than November 15, 2007, the 

23 Comptroller General of the United States shall conduct 

24 a study— 

25 (1) to identify and describe each anti-fraud and 

26 abuse provision (including intermediate sanctions re-
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1 lating to such provisions) that is applicable to an 

2 MA–PD plan under part C of title XVIII of the So3 cial Security Act or a prescription drug plan under 

4 part D of such title; and 

5 (2) to assess the effectiveness of the provisions 

6 described in paragraph (1) and the overall compli7 ance of MA–PD plans under part C of title XVIII 

8 of such Act and prescription drug plans under part 

9 D of such title with such provisions. 

10 (b) REPORT.—Not later than May 15, 2008, the 

11 Comptroller General of the United States shall submit a 

12 report to Congress of the results of the study under sub13 section (a). 

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