Florida Senate - 2014                        COMMITTEE AMENDMENT
       Bill No. CS for SB 702
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/02/2014           .                                

    1         Senate Amendment (with title amendment)
    3         Delete lines 28 - 72
    4  and insert:
    5         (b) To have the on-site audit scheduled after the first 3
    6  calendar days of a month unless the pharmacist consents
    7  otherwise.
    8         (c) To have the audit period limited to 24 months after the
    9  date a claim is submitted to or adjudicated by the entity.
   10         (d) To have an audit that requires clinical or professional
   11  judgment conducted by or in consultation with a pharmacist.
   12         (e) To use the written and verifiable records of a
   13  hospital, physician, or other authorized practitioner, which are
   14  transmitted by any means of communication, to validate the
   15  pharmacy records in accordance with state and federal law.
   16         (f) To be reimbursed for a claim that was retroactively
   17  denied for a clerical error, typographical error, scrivener’s
   18  error, or computer error if the prescription was properly and
   19  correctly dispensed, unless a pattern of such errors exists,
   20  fraudulent billing is alleged, or the error results in actual
   21  financial loss to the entity.
   22         (g) To receive the preliminary audit report within 120 days
   23  after the conclusion of the audit.
   24         (h) To produce documentation to address a discrepancy or
   25  audit finding within 10 business days after the preliminary
   26  audit report is delivered to the pharmacy.
   27         (i) To receive the final audit report within 6 months after
   28  receiving the preliminary audit report.
   29         (j) To have recoupment or penalties based on actual
   30  overpayments and not according to the accounting practice of
   31  extrapolation.
   32         (2) The rights contained in this section do not apply to:
   33         (a) Audits in which suspected fraudulent activity or other
   34  intentional or wilful misrepresentation is evidenced by a
   35  physical review, review of claims data or statements, or other
   36  investigative methods.
   37         (b) Audits of claims paid for by federally funded programs;
   38         (c) Concurrent reviews or desk audits that occur within 3
   39  business days of transmission of a claim and where no chargeback
   40  or recoupment is demanded; or
   41         (d) Audits related to fee-for-service claims under the
   42  Medicaid program.
   43         (3) An entity that audits a pharmacy located within a
   44  Health Care Fraud Prevention and Enforcement Action Team (HEAT)
   45  Task Force area designated by the United States Department of
   46  Health and Human Services and the United States Department of
   47  Justice may dispense with the notice requirements of paragraph
   48  (1)(a) if such pharmacy has been a member of a provider network
   49  for less than 12 months.
   50         Section 2. This act shall take effect October 1, 2014.
   52  ================= T I T L E  A M E N D M E N T ================
   53  And the title is amended as follows:
   54         Delete lines 5 - 11
   55  and insert:
   56         are conducted by certain entities; providing a list of
   57         audits not subject to such rights; providing an
   58         exemption from the right to notice of an on-site audit
   59         under certain circumstances; providing an effective