Florida Senate - 2014 CS for SB 702 By the Committee on Regulated Industries; and Senators Bean and Sobel 580-02547-14 2014702c1 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; requiring the 6 Office of Insurance Regulation to investigate 7 complaints alleging a violation of pharmacy rights; 8 providing that a willful violation of such rights is 9 an unfair claim settlement practice; exempting audits 10 in which fraudulent activity is suspected or which are 11 related to Medicaid claims; providing an effective 12 date. 13 14 Be It Enacted by the Legislature of the State of Florida: 15 16 Section 1. Section 465.1885, Florida Statutes, is created 17 to read: 18 465.1885 Pharmacy audits; rights.— 19 (1) If an audit of the records of a pharmacy licensed under 20 this chapter is conducted directly or indirectly by a managed 21 care company, an insurance company, a third-party payor, a 22 pharmacy benefit manager, or an entity that represents 23 responsible parties such as companies or groups, referred to as 24 an “entity” in this section, the pharmacy has the following 25 rights: 26 (a) To be notified at least 7 calendar days before the 27 initial on-site audit for each audit cycle. 28 (b) To have the on-site audit scheduled after the first 5 29 calendar days of a month unless the pharmacist consents 30 otherwise. 31 (c) To have the audit period limited to 24 months after the 32 date a claim is submitted to or adjudicated by the entity. 33 (d) To have an audit that requires clinical or professional 34 judgment conducted by or in consultation with a pharmacist. 35 (e) To use the records of a hospital, physician, or other 36 authorized practitioner, which are transmitted by any means of 37 communication, to validate the pharmacy records in accordance 38 with state and federal law. 39 (f) To be reimbursed for a claim that was retroactively 40 denied for a clerical error, typographical error, scrivener’s 41 error, or computer error if the prescription was properly and 42 correctly dispensed, unless a pattern of such errors exists, 43 fraudulent billing is alleged, or the error results in actual 44 financial loss to the entity. For the purposes of this section, 45 a prescription is properly and correctly dispensed if the 46 pharmacy dispenses the correct drug to the correct patient with 47 the correct issuing directions. 48 (g) To receive the preliminary audit report within 120 days 49 after the conclusion of the audit. 50 (h) To produce documentation to address a discrepancy or 51 audit finding within 10 business days after the preliminary 52 audit report is delivered to the pharmacy. 53 (i) To receive the final audit report within 6 months after 54 receiving the preliminary audit report. 55 (j) To have recoupment or penalties based on actual 56 overpayments and not according to the accounting practice of 57 extrapolation. 58 (2) The Office of Insurance Regulation shall investigate a 59 complaint received from a pharmacy which alleges a willful 60 violation of this section by an entity conducting an audit of 61 the pharmacy on behalf of a managed care company or insurance 62 company regulated by the office. Such complaint must be in 63 writing, signed by an authorized representative of the affected 64 pharmacy, and contain ultimate facts that demonstrate a 65 violation of this section. A violation of this section is an 66 unfair claim settlement practice as described in s. 67 641.3903(5)(c)1. and 4., enforceable against the entity as 68 provided in part I of chapter 641 and s. 626.9521. 69 (3) The rights contained in this section do not apply to 70 audits in which fraudulent activity is suspected or to audits 71 related to fee-for-service claims under the Medicaid program. 72 Section 2. This act shall take effect July 1, 2014.