A bill has been introduced in the Florida Legislature that would give pharmacies greater rights with respect to audits. Many pharmacies have complained that audits by or on behalf of pharmacy benefit managers (PBMs) are used simply to generate revenue and unfairly penalize pharmacies for minor issues, some of which are not the fault of the pharmacy.
The proposed legislation, Senate Bill 702 and House Bill 745, would allow pharmacies to be reimbursed for minor clerical or typographical errors discovered in the course of an audit and would allow them to use hospital or physician records to support their records in response to an audit. Moreover, pharmacies would be entitled to sue auditors for certain abusive practices. Among other things, the legislation would require auditors to provide at least seven days’ advance notice before an onsite audit and limit the audit period to two years from the date a claim was submitted to or ruled on by the entity conducting the audit.
The legislation also sets forth specific time frames for pharmacies to receive the preliminary audit report and the final audit report and the right to have penalties based on actual overpayments. Importantly, however, audits related to Medicaid claims or in which fraudulent activity is suspected are exempt from the legislation.
Blalock Walters’ health care services group will continue to monitor the progress of this legislation. Please contact one of our health care attorneys for more information.