Florida Senate - 2014                              CS for SB 702
       By the Committee on Regulated Industries; and Senators Bean and
       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.
   14  Be It Enacted by the Legislature of the State of Florida:
   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.