Florida Senate - 2014                                     SB 702
       By Senator Bean
       4-01182-14                                             2014702__
    1                        A bill to be entitled                      
    2         An act relating to pharmacy audits; creating s.
    3         465.1885, F.S.; enumerating the rights of pharmacies
    4         relating to audits of pharmaceutical services which
    5         are conducted by certain entities; exempting audits in
    6         which fraudulent activity is suspected or which are
    7         related to Medicaid claims; establishing a claim for
    8         civil damages if the pharmacy’s rights are violated;
    9         providing an effective date.
   11  Be It Enacted by the Legislature of the State of Florida:
   13         Section 1. Section 465.1885, Florida Statutes, is created
   14  to read:
   15         465.1885 Pharmacy audits; rights.—
   16         (1) If an audit of the records of a pharmacy licensed under
   17  this chapter is conducted directly or indirectly by a managed
   18  care company, an insurance company, a third-party payor, a
   19  pharmacy benefit manager, or an entity that represents
   20  responsible parties such as companies or groups, referred to as
   21  an “entity” in this section, the pharmacy has the following
   22  rights:
   23         (a) To be notified at least 7 calendar days before the
   24  initial on-site audit for each audit cycle.
   25         (b) To have the on-site audit scheduled after the first 5
   26  calendar days of a month unless the pharmacist consents
   27  otherwise.
   28         (c) To have the audit period limited to 24 months after the
   29  date a claim is submitted to or adjudicated by the entity.
   30         (d) To have an audit that requires clinical or professional
   31  judgment conducted by or in consultation with a pharmacist.
   32         (e) To use the records of a hospital, physician, or other
   33  authorized practitioner, which are transmitted by any means of
   34  communication, to validate the pharmacy records.
   35         (f) To be reimbursed for a claim that was retroactively
   36  denied for a clerical error, typographical error, scrivener’s
   37  error, or computer error if the prescription was properly and
   38  correctly dispensed, unless a pattern of such errors exists or
   39  fraudulent billing is alleged.
   40         (g) To receive the preliminary audit report within 90 days
   41  after the conclusion of the audit.
   42         (h) To produce documentation to address a discrepancy or
   43  audit finding within 10 business days after the preliminary
   44  audit report is delivered to the pharmacy.
   45         (i) To receive the final audit report within 6 months after
   46  receiving the preliminary audit report.
   47         (j) To have recoupment or penalties based on actual
   48  overpayments and not according to the accounting practice of
   49  extrapolation.
   50         (2) The rights contained in this section do not apply to
   51  audits in which fraudulent activity is suspected or to audits
   52  related to fee-for-service claims under the Medicaid program.
   53         (3) A pharmacy injured as a result of a willful violation
   54  of this section shall have a civil cause of action for treble
   55  damages, reasonable attorney fees, and costs.
   56         Section 2. This act shall take effect July 1, 2014.