I 

115TH CONGRESS 

2D SESSION H. R. 5676 

To amend title XVIII of the Social Security Act to authorize the suspension 

of payments by Medicare prescription drug plans and MA–PD plans 

pending investigations of credible allegations of fraud by pharmacies. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 3, 2018 

Mr. MACARTHUR (for himself, Mr. COLLINS of New York, Mr. SCHWEIKERT, 

Ms. KUSTER of New Hampshire, Mr. BLUMENAUER, and Mr. TONKO) 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 authorize 

the suspension of payments by Medicare prescription 

drug plans and MA–PD plans pending investigations of 

credible allegations of fraud by pharmacies. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Stop Excessive Nar5 cotics in our Retirement Communities Protection Act’’ or 

6 the ‘‘SENIOR Communities Protection Act’’. 


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•HR 5676 IH

1 SEC. 2. SUSPENSION OF PAYMENTS BY MEDICARE PRE2 SCRIPTION DRUG PLANS AND MA–PD PLANS 

3 PENDING INVESTIGATIONS OF CREDIBLE AL4 LEGATIONS OF FRAUD BY PHARMACIES. 

5 (a) IN GENERAL.—Section 1860D–12(b) of the So6 cial Security Act (42 U.S.C. 1395w–112(b)) is amended 

7 by adding at the end the following new paragraph: 

8 ‘‘(7) SUSPENSION OF PAYMENTS PENDING IN9 VESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD

10 BY PHARMACIES.— 

11 ‘‘(A) IN GENERAL.—The provisions of sec12 tion 1862(o) shall apply with respect to a PDP 

13 sponsor with a contract under this part, a phar14 macy, and payments to such pharmacy under 

15 this part in the same manner as such provisions 

16 apply with respect to the Secretary, a provider 

17 of services or supplier, and payments to such 

18 provider of services or supplier under this title. 

19 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 

20 in this paragraph shall be construed as limiting 

21 the authority of a PDP sponsor to conduct 

22 postpayment review.’’. 

23 (b) APPLICATION TO MA–PD PLANS.—Section 

24 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w– 

25 27(f)(3)) is amended by adding at the end the following 

26 new subparagraph: 


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•HR 5676 IH

1 ‘‘(D) SUSPENSION OF PAYMENTS PENDING

2 INVESTIGATION OF CREDIBLE ALLEGATIONS OF

3 FRAUD BY PHARMACIES.—Section 1860D– 

4 12(b)(7).’’. 

5 (c) CONFORMING AMENDMENT.—Section 1862(o)(3) 

6 of the Social Security Act (42 U.S.C. 1395y(o)(3)) is 

7 amended by inserting ‘‘, section 1860D–12(b)(7) (includ8 ing as applied pursuant to section 1857(f)(3)(D)),’’ after 

9 ‘‘this subsection’’. 

10 (d) CLARIFICATION RELATING TO CREDIBLE ALLE11 GATION OF FRAUD.—Section 1862(o) of the Social Secu12 rity Act (42 U.S.C. 1395y(o)) is amended by adding at 

13 the end the following new paragraph: 

14 ‘‘(4) CREDIBLE ALLEGATION OF FRAUD.—In 

15 carrying out this subsection, section 1860D– 

16 12(b)(7) (including as applied pursuant to section 

17 1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 

18 hotline tip (as defined by the Secretary) without fur19 ther evidence shall not be treated as sufficient evi20 dence for a credible allegation of fraud.’’. 

21 (e) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply with respect to plan years begin23 ning on or after January 1, 2020. 

Æ 


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