115TH CONGRESS 

2D SESSION H. R. 5676 

AN ACT 

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, 
2 

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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Stop Excessive Nar3 cotics in our Retirement Communities Protection Act of 

4 2018’’ or the ‘‘SENIOR Communities Protection Act of 

5 2018’’. 

6 SEC. 2. SUSPENSION OF PAYMENTS BY MEDICARE PRE7 SCRIPTION DRUG PLANS AND MA–PD PLANS 

8 PENDING INVESTIGATIONS OF CREDIBLE AL9 LEGATIONS OF FRAUD BY PHARMACIES. 

10 (a) IN GENERAL.—Section 1860D–12(b) of the So11 cial Security Act (42 U.S.C. 1395w–112(b)) is amended 

12 by adding at the end the following new paragraph: 

13 ‘‘(7) SUSPENSION OF PAYMENTS PENDING IN14 VESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD

15 BY PHARMACIES.— 

16 ‘‘(A) IN GENERAL.—The provisions of sec17 tion 1862(o) shall apply with respect to a PDP 

18 sponsor with a contract under this part, a phar19 macy, and payments to such pharmacy under 

20 this part in the same manner as such provisions 

21 apply with respect to the Secretary, a provider 

22 of services or supplier, and payments to such 

23 provider of services or supplier under this title. 

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

25 in this paragraph shall be construed as limiting 
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1 the authority of a PDP sponsor to conduct 

2 postpayment review.’’. 

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

4 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w– 

5 27(f)(3)) is amended by adding at the end the following 

6 new subparagraph: 

7 ‘‘(D) SUSPENSION OF PAYMENTS PENDING

8 INVESTIGATION OF CREDIBLE ALLEGATIONS OF

9 FRAUD BY PHARMACIES.—Section 1860D– 

10 12(b)(7).’’. 

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

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

13 amended by inserting ‘‘, section 1860D–12(b)(7) (includ14 ing as applied pursuant to section 1857(f)(3)(D)),’’ after 

15 ‘‘this subsection’’. 

16 (d) CLARIFICATION RELATING TO CREDIBLE ALLE17 GATION OF FRAUD.—Section 1862(o) of the Social Secu18 rity Act (42 U.S.C. 1395y(o)) is amended by adding at 

19 the end the following new paragraph: 

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

21 carrying out this subsection, section 1860D– 

22 12(b)(7) (including as applied pursuant to section 

23 1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 

24 hotline tip (as defined by the Secretary) without fur-
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1 ther evidence shall not be treated as sufficient evi2 dence for a credible allegation of fraud.’’. 

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

4 this section shall apply with respect to plan years begin5 ning on or after January 1, 2020. 

Passed the House of Representatives June 19, 2018. 

Attest: 

Clerk. 

115TH CONGRESS 

2D SESSION H. R. 5676 

AN ACT 

To amend title XVIII of the Social Security Act to 

fraud by pharmacies. pending investigations of credible allegations of care prescription drug plans and MA–PD plans authorize the suspension of payments by Medi-