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) in-
troduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Stop Excessive Nar-
cotics in our Retirement Communities Protection Act’’ or 
the ‘‘SENIOR Communities Protection Act’’. 
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SEC. 2. SUSPENSION OF PAYMENTS BY MEDICARE PRE-
SCRIPTION DRUG PLANS AND MA–PD PLANS 
PENDING INVESTIGATIONS OF CREDIBLE AL-
LEGATIONS OF FRAUD BY PHARMACIES. 
(a) IN GENERAL.—Section 1860D–12(b) of the So-
cial Security Act (42 U.S.C. 1395w–112(b)) is amended 
by adding at the end the following new paragraph: 
‘‘(7) SUSPENSION OF PAYMENTS PENDING IN-
VESTIGATION OF CREDIBLE ALLEGATIONS OF FRAUD 
BY PHARMACIES.— 
‘‘(A) IN GENERAL.—The provisions of sec-
tion 1862(o) shall apply with respect to a PDP 
sponsor with a contract under this part, a phar-
macy, and payments to such pharmacy under 
this part in the same manner as such provisions 
apply with respect to the Secretary, a provider 
of services or supplier, and payments to such 
provider of services or supplier under this title. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing 
in this paragraph shall be construed as limiting 
the authority of a PDP sponsor to conduct 
postpayment review.’’. 
(b) APPLICATION
TO
MA–PD PLANS.—Section 
1857(f)(3) of the Social Security Act (42 U.S.C. 1395w– 
27(f)(3)) is amended by adding at the end the following 
new subparagraph: 
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‘‘(D) SUSPENSION OF PAYMENTS PENDING 
INVESTIGATION OF CREDIBLE ALLEGATIONS OF 
FRAUD
BY
PHARMACIES.—Section 
1860D– 
12(b)(7).’’. 
(c) CONFORMING AMENDMENT.—Section 1862(o)(3) 
of the Social Security Act (42 U.S.C. 1395y(o)(3)) is 
amended by inserting ‘‘, section 1860D–12(b)(7) (includ-
ing as applied pursuant to section 1857(f)(3)(D)),’’ after 
‘‘this subsection’’. 
(d) CLARIFICATION RELATING TO CREDIBLE ALLE-
GATION OF FRAUD.—Section 1862(o) of the Social Secu-
rity Act (42 U.S.C. 1395y(o)) is amended by adding at 
the end the following new paragraph: 
‘‘(4) CREDIBLE
ALLEGATION
OF
FRAUD.—In 
carrying out this subsection, section 1860D– 
12(b)(7) (including as applied pursuant to section 
1857(f)(3)(D)), and section 1903(i)(2)(C), a fraud 
hotline tip (as defined by the Secretary) without fur-
ther evidence shall not be treated as sufficient evi-
dence for a credible allegation of fraud.’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2020. 
Æ 
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