Florida Senate - 2014                CS for CS for CS for SB 702
       By the Committees on Appropriations; Judiciary; and Regulated
       Industries; and Senators Bean and Sobel
       576-04218-14                                           2014702c3
    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; providing a list of
    6         audits not subject to such rights; providing an
    7         exemption from the right to notice of an on-site audit
    8         under certain circumstances; providing an effective
    9         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 3
   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 written and verifiable records of a
   33  hospital, physician, or other authorized practitioner, which are
   34  transmitted by any means of communication, to validate the
   35  pharmacy records in accordance with state and federal law.
   36         (f) To be reimbursed for a claim that was retroactively
   37  denied for a clerical error, typographical error, scrivener’s
   38  error, or computer error if the prescription was properly and
   39  correctly dispensed, unless a pattern of such errors exists,
   40  fraudulent billing is alleged, or the error results in actual
   41  financial loss to the entity.
   42         (g) To receive the preliminary audit report within 120 days
   43  after the conclusion of the audit.
   44         (h) To produce documentation to address a discrepancy or
   45  audit finding within 10 business days after the preliminary
   46  audit report is delivered to the pharmacy.
   47         (i) To receive the final audit report within 6 months after
   48  receiving the preliminary audit report.
   49         (j) To have recoupment or penalties based on actual
   50  overpayments and not according to the accounting practice of
   51  extrapolation.
   52         (2) The rights contained in this section do not apply to:
   53         (a) Audits in which suspected fraudulent activity or other
   54  intentional or willful misrepresentation is evidenced by a
   55  physical review, review of claims data or statements, or other
   56  investigative methods;
   57         (b) Audits of claims paid for by federally funded programs;
   58  or
   59         (c) Concurrent reviews or desk audits that occur within 3
   60  business days of transmission of a claim and where no chargeback
   61  or recoupment is demanded.
   62         (3) An entity that audits a pharmacy located within a
   63  Health Care Fraud Prevention and Enforcement Action Team (HEAT)
   64  Task Force area designated by the United States Department of
   65  Health and Human Services and the United States Department of
   66  Justice may dispense with the notice requirements of paragraph
   67  (1)(a) if such pharmacy has been a member of a credentialed
   68  provider network for less than 12 months.
   69         Section 2. This act shall take effect October 1, 2014.