Florida Senate - 2014                        COMMITTEE AMENDMENT
       Bill No. SB 702
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  03/17/2014           .                                

    1         Senate Amendment (with title amendment)
    3         Delete lines 32 - 52
    4  and insert:
    5         (e) To use the records of a hospital, physician, or other
    6  authorized practitioner, which are transmitted by any means of
    7  communication, to validate the pharmacy records in accordance
    8  with state and federal law.
    9         (f) To be reimbursed for a claim that was retroactively
   10  denied for a clerical error, typographical error, scrivener’s
   11  error, or computer error if the prescription was properly and
   12  correctly dispensed, unless a pattern of such errors exists,
   13  fraudulent billing is alleged, or the error results in actual
   14  financial loss to the entity. For the purposes of this section,
   15  a prescription is properly and correctly dispensed if the
   16  pharmacy dispenses the correct drug to the correct patient with
   17  the correct issuing directions.
   18         (g) To receive the preliminary audit report within 120 days
   19  after the conclusion of the audit.
   20         (h) To produce documentation to address a discrepancy or
   21  audit finding within 10 business days after the preliminary
   22  audit report is delivered to the pharmacy.
   23         (i) To receive the final audit report within 6 months after
   24  receiving the preliminary audit report.
   25         (j) To have recoupment or penalties based on actual
   26  overpayments and not according to the accounting practice of
   27  extrapolation.
   28         (2) The Office of Insurance Regulation shall investigate a
   29  complaint received from a pharmacy which alleges a willful
   30  violation of this section by an entity conducting an audit of
   31  the pharmacy on behalf of a managed care company or insurance
   32  company regulated by the office. Such complaint must be in
   33  writing, signed by an authorized representative of the affected
   34  pharmacy, and contain ultimate facts that demonstrate a
   35  violation of this section. A violation of this section is an
   36  unfair claim settlement practice as described in s.
   37  641.3903(5)(c)1. and 4., enforceable against the entity as
   38  provided in part I of chapter 641 and s. 626.9521.
   40  ================= T I T L E  A M E N D M E N T ================
   41  And the title is amended as follows:
   42         Delete lines 5 - 8
   43  and insert:
   44         are conducted by certain entities; requiring the
   45         office to investigate complaints alleging a violation
   46         of pharmacy rights; providing that a willful violation
   47         of such rights is an unfair claim settlement practice;
   48         exempting audits in which fraudulent activity is
   49         suspected or which are related to Medicaid claims;