cluding for not satisfying conditions of par-
ticipation. 
‘‘(iv) In the case of such a plan that 
makes a referral under subparagraph 
(A)(i) through the portal (or other suc-
cessor technology) with respect to activities 
of substantiated fraud, waste, or abuse of 
a provider of services or supplier, if such 
provider or supplier has been the subject of 
an administrative action under this title or 
title XI with respect to similar activities, a 
notification to such plan of such action so 
taken. 
‘‘(C) RULEMAKING.—For purposes of this 
paragraph, the Secretary shall, through rule-
making, specify what constitutes substantiated 
fraud, waste, and abuse, using guidance such as 
what is provided in the Medicare Program In-
tegrity Manual 4.7.1. 
‘‘(D) HIPAA COMPLIANT
INFORMATION 
ONLY.—For purposes of this subsection, com-
munications may only occur if the communica-
tions are permitted under the Federal regula-
tions (concerning the privacy of individually 
identifiable health information) promulgated 
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under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996. 
‘‘(2) QUARTERLY
REPORTS.—Beginning two 
years after the date of enactment of this subsection, 
the Secretary shall make available to MA plans 
under this part and prescription drug plans under 
part D in a timely manner (but no less frequently 
than quarterly) and using information submitted to 
an entity described in paragraph (1) through the 
portal (or other successor technology) described in 
such paragraph or pursuant to section 1893, infor-
mation on fraud, waste, and abuse schemes and 
trends in identifying suspicious activity. Information 
included in each such report shall— 
‘‘(A) include administrative actions, perti-
nent information related to opioid overpre-
scribing, and other data determined appropriate 
by the Secretary in consultation with stake-
holders; and 
‘‘(B) be anonymized information submitted 
by plans without identifying the source of such 
information. 
‘‘(3) CLARIFICATION.—Nothing in this sub-
section shall be construed as precluding or otherwise 
affecting referrals described in subparagraph (A) 
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that may otherwise be made to law enforcement en-
tities or to the Secretary.’’. 
(b) CONTRACT REQUIREMENT TO COMMUNICATE 
PLAN CORRECTIVE ACTIONS AGAINST OPIOIDS OVER- 
PRESCRIBERS.—Section 1857(e)(4)(C) of the Social Secu-
rity Act (42 U.S.C. 1395w–27(e)(4)(C)) is amended by 
adding at the end the following new paragraph: 
‘‘(5) COMMUNICATING
PLAN
CORRECTIVE
AC-
TIONS AGAINST OPIOIDS OVER-PRESCRIBERS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2021, a 
contract under this section with an MA organi-
zation shall require the organization to submit 
to the Secretary, through the process estab-
lished under subparagraph (B), information on 
the investigations and other actions taken by 
such plans related to providers of services who 
prescribe a high volume of opioids. 
‘‘(B) PROCESS.—Not later than January 
1, 2021, the Secretary shall, in consultation 
with stakeholders, establish a process under 
which MA plans and prescription drug plans 
shall submit to the Secretary information de-
scribed in subparagraph (A). 
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‘‘(C) REGULATIONS.—For purposes of this 
paragraph, including as applied under section 
1860D–12(b)(3)(D), the Secretary shall, pursu-
ant to rulemaking— 
‘‘(i) specify a definition for the term 
‘high volume of opioids’ and a method for 
determining if a provider of services pre-
scribes such a high volume; and 
‘‘(ii) establish the process described in 
subparagraph (B) and the types of infor-
mation that shall be submitted through 
such process.’’. 
(c) REFERENCE UNDER PART D TO PROGRAM IN-
TEGRITY TRANSPARENCY MEASURES.—Section 1860D–4 
of the Social Security Act (42 U.S.C. 1395w–104) is 
amended by adding at the end the following new sub-
section: 
‘‘(m) PROGRAM INTEGRITY TRANSPARENCY MEAS-
URES.—For program integrity transparency measures ap-
plied with respect to prescription drug plan and MA plans, 
see section 1859(i).’’. 
Æ 
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