Senate Bill sb1428er

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    ENROLLED

    2003 Legislature    CS for CS for SB 1428, 1st Engrossed (ntc)



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  2         An act relating to Medicaid audits of

  3         pharmacies; providing requirements for an audit

  4         conducted of the Medicaid-related records of a

  5         pharmacy licensed under ch. 465, F.S.;

  6         requiring that a pharmacist be provided prior

  7         notice of the audit; providing that a

  8         pharmacist is not subject to criminal penalties

  9         without proof of intent to commit fraud;

10         providing that an underpayment or overpayment

11         may not be based on certain projections;

12         requiring that all pharmacies be audited under

13         the same standards; limiting the period that

14         may be covered by an audit; requiring that the

15         Agency for Health Care Administration establish

16         a procedure for conducting a preliminary

17         review; authorizing the agency to establish

18         peer-review panels; requiring that the agency

19         dismiss an unfavorable audit report if it or a

20         review panel finds that the pharmacist did not

21         commit intentional fraud; exempting certain

22         audits conducted by the Medicaid Fraud Control

23         Unit of the Department of Legal Affairs;

24         providing an effective date.

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26  Be It Enacted by the Legislature of the State of Florida:

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28         Section 1.  Medicaid audits of pharmacies.--

29         (1)  Notwithstanding any other law, when an audit of

30  the Medicaid-related records of a pharmacy licensed under

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CODING: Words stricken are deletions; words underlined are additions.




    ENROLLED

    2003 Legislature    CS for CS for SB 1428, 1st Engrossed (ntc)



 1  chapter 465, Florida Statutes, is conducted, such audit must

 2  be conducted as provided in this section.

 3         (a)  The agency conducting the audit must give the

 4  pharmacist at least 1 weeks' prior notice of the audit.

 5         (b)  An audit must be conducted by a pharmacist

 6  licensed in this state.

 7         (c)  Any clerical or recordkeeping error, such as a

 8  typographical error, scrivener's error, or computer error

 9  regarding a document or record required under the Medicaid

10  program does not constitute a willful violation and is not

11  subject to criminal penalties without proof of intent to

12  commit fraud.

13         (d)  A pharmacist may use the physician's record or

14  other order for drugs or medicinal supplies written or

15  transmitted by any means of communication for purposes of

16  validating the pharmacy record with respect to orders or

17  refills of a legend or narcotic drug.

18         (e)  A finding of an overpayment or underpayment must

19  be based on the actual overpayment or underpayment and may not

20  be a projection based on the number of patients served having

21  a similar diagnosis or on the number of similar orders or

22  refills for similar drugs.

23         (f)  Each pharmacy shall be audited under the same

24  standards and parameters.

25         (g)  A pharmacist must be allowed at least 10 days in

26  which to produce documentation to address any discrepancy

27  found during an audit.

28         (h)  The period covered by an audit may not exceed 1

29  calendar year.

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CODING: Words stricken are deletions; words underlined are additions.




    ENROLLED

    2003 Legislature    CS for CS for SB 1428, 1st Engrossed (ntc)



 1         (i)  An audit may not be scheduled during the first 5

 2  days of any month due to the high volume of prescriptions

 3  filled during that time.

 4         (j)  The audit report must be delivered to the

 5  pharmacist within 90 days after conclusion of the audit. A

 6  final audit report shall be delivered to the pharmacist within

 7  6 months after receipt of the preliminary audit report or

 8  final appeal, as provided for in subsection (2), whichever is

 9  later.

10         (2)  The Agency for Health Care Administration shall

11  establish a process under which a pharmacist may obtain a

12  preliminary review of an audit report and may appeal an

13  unfavorable audit report without the necessity of obtaining

14  legal counsel. The preliminary review and appeal may be

15  conducted by an ad hoc peer-review panel, appointed by the

16  agency, which consists of pharmacists who maintain an active

17  practice. If, following the preliminary review, the agency or

18  review panel finds that an unfavorable audit report is

19  unsubstantiated, the agency shall dismiss the audit report

20  without the necessity of any further proceedings.

21         (3)  This section does not apply to investigative

22  audits conducted by the Medicaid Fraud Control Unit of the

23  Department of Legal Affairs.

24         Section 2.  This act shall take effect upon becoming a

25  law.

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