Sec. 2008. Suspension of payments by Medicare prescription drug plans and MA–PD plans pending investigations of credible allegations of fraud by pharmacies
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Section 1860D–12(b) of the Social Security Act ( 42 U.S.C. 1395w–112(b) ) is amended by adding at the end the following new paragraph: Section 1862(o)(1) shall apply with respect to a PDP sponsor with a contract under this part, a pharmacy, and payments to such pharmacy under this part in the same manner as such section applies with respect to the Secretary, a provider of services or supplier, and payments to such provider of services or supplier under this title. A PDP sponsor shall notify the Secretary regarding the imposition of any payment suspension pursuant to the previous sentence, such as through the secure internet website portal (or other successor technology) established under section 1859(i).
Nothing in this paragraph shall be construed as limiting the authority of a PDP sponsor to conduct postpayment review. . 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: Section 1860D–12(b)(7). . 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) (including as applied pursuant to section 1857(f)(3)(D)), after this subsection .
Section 1862(o) of the Social Security Act ( 42 U.S.C. 1395y(o) ) is amended by adding at the end the following new paragraph: 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 further evidence shall not be treated as sufficient evidence for a credible allegation of fraud. . The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2020.
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- 42 USC 1395w–112(b)
- 42 USC 1395w–27(f)(3)
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Sec. 2008
Suspension of payments by Medicare prescription drug plans and MA–PD plans pending investigations of credible allegations of fraud by pharmacies
Cite42 USC 1395w–112(b)
Cite42 USC 1395w–27(f)(3)
Cites 3Cited by 0 across 0 sources