Beginning Aug. 1, 2012, entities that audit pharmacies will have new parameters for conducting the audits.
Rep. Rod Hamilton (R-Mountain Lake) and Sen. Gretchen Hoffman (R-Vergas) sponsor the new law, which provides a framework for audit procedures, an appeals process and prescribes who holds onto funds in question during the audit proceedings.
Pharmacists in Hamilton’s district said up to $6,000 in state and federal Medicaid payments were withheld from one rural pharmacist. Another pharmacist said a $200 claim was not paid because the prescription was faxed into the pharmacy, but the pharmacy attendant had checked that it was called in on the phone.
Newly established audit standards will require:
• giving a pharmacy 14 days notice before an initial on-site audit is conducted;
• consulting with the licensed pharmacist when the audit involves clinical or professional judgments;
• applying the same audit standards and parameters to each pharmacy;
• limiting an audit period to no more than 24 months;
• establishing a written appeals process and reporting back within specific timeframes; and
• disclosing the audit claims and returning any recouped funds to the employee benefit plan or plan sponsor.
The law was signed by Gov. Mark Dayton April 23.
HF1236*/
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