HB 0413 2003
1	CHAMBER ACTION
2
3
4
5
6	The Committee on Health Care recommends the following:
7
8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to Medicaid audits of pharmacies;
12	providing requirements for an audit conducted of the
13	Medicaid-related records of a pharmacy licensed under ch.
14	465, F.S.; requiring that a pharmacist be provided prior
15	notice of the audit; providing that a pharmacist is not
16	subject to criminal penalties without proof of intent to
17	commit fraud; providing that an underpayment or
18	overpayment may not be based on certain projections;
19	requiring that all pharmacies be audited under the same
20	standards; limiting the period that may be covered by an
21	audit; providing for delivery of preliminary and final
22	audit reports; requiring that the Agency for Health Care
23	Administration establish a procedure for conducting a
24	preliminary review; authorizing the agency to establish
25	peer-review panels; requiring that the agency dismiss an
26	unfavorable audit report if it or a review panel finds
27	that the pharmacist did not commit intentional fraud;
28	exempting certain audits conducted by the Medicaid Fraud
29	Control Unit of the Department of Legal Affairs; providing
30	an effective date.
31
32	Be It Enacted by the Legislature of the State of Florida:
33
34	Section 1. Medicaid audits of pharmacies.--
35	(1) Notwithstanding any other law, when an audit of the
36	Medicaid-related records of a pharmacy licensed under chapter
37	465, Florida Statutes, is conducted, such audit must be
38	conducted as provided in this section.
39	(a) The agency conducting the audit must give the
40	pharmacist at least 1 week's prior notice of the audit.
41	(b) An audit must be conducted by a pharmacist licensed in
42	this state.
43	(c) Any clerical or recordkeeping error, such as a
44	typographical error, scrivener's error, or computer error,
45	regarding a document or record required under the Medicaid
46	program does not constitute a willful violation and is not
47	subject to criminal penalties without proof of intent to commit
48	fraud.
49	(d) A pharmacist may use the physician's record or other
50	order for drugs or medicinal supplies written or transmitted by
51	any means of communication for purposes of validating the
52	pharmacy record with respect to orders or refills of a legend or
53	narcotic drug.
54	(e) A finding of an overpayment or underpayment must be
55	based on the actual overpayment or underpayment and may not be a
56	projection based on the number of patients served having a
57	similar diagnosis or on the number of similar orders or refills
58	for similar drugs.
59	(f) Each pharmacy shall be audited under the same
60	standards and parameters.
61	(g) A pharmacist must be allowed at least 10 days in which
62	to produce documentation to address any discrepancy found during
63	an audit.
64	(h) The period covered by an audit may not exceed 1
65	calendar year.
66	(i) An audit may not be scheduled during the first 5 days
67	of any month due to the high volume of prescriptions filled
68	during that time.
69	(j) The preliminary audit report must be delivered to the
70	pharmacist within 90 days after conclusion of the audit. A final
71	audit report shall be delivered to the pharmacist within 6
72	months after receipt of the preliminary audit report or final
73	appeal, as provided for in subsection (2), whichever is later.
74	(2) The Agency for Health Care Administration shall
75	establish a process under which a pharmacist may obtain a
76	preliminary review of an audit report and may appeal an
77	unfavorable audit report without the necessity of obtaining
78	legal counsel. The preliminary review and appeal may be
79	conducted by an ad hoc peer-review panel, appointed by the
80	agency, which consists of pharmacists who maintain an active
81	practice. If, following the preliminary review, the agency or
82	review panel finds that an unfavorable audit report lacks merit
83	and finds that the pharmacist did not commit intentional fraud,
84	the agency shall dismiss the audit report without the necessity
85	of any further proceedings.
86	(3) This section does not apply to investigative audits
87	conducted by the Medicaid Fraud Control Unit of the Department
88	of Legal Affairs.
89	Section 2. This act shall take effect upon becoming a law.