Bill Text: GA HB1125 | 2011-2012 | Regular Session | Introduced

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Bill Title: The Pharmacy Audit Bill of Rights; recoupment pursuant to an audit under certain circumstances; limit

Spectrum: Partisan Bill (Republican 5-0)

Status: (Introduced - Dead) 2012-02-23 - House Second Readers [HB1125 Detail]

Download: Georgia-2011-HB1125-Introduced.html

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12 LC 33 4639

House Bill 1125

By: Representatives Harden of the 147th, Stephens of the 164th, Allison of the 8th, Harden of the 28th, and Jasperse of the 12th

A BILL TO BE ENTITLED
AN ACT

To amend Code Section 26-4-118 of the Official Code of Georgia Annotated, relating to "The Pharmacy Audit Bill of Rights," so as to limit recoupment pursuant to an audit under certain circumstances; to require audit parameters to be equally applied to local and mail-order pharmacies; to provide for independent audits by the state; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Code Section 26-4-118 of the Official Code of Georgia Annotated, relating to "The Pharmacy Audit Bill of Rights," is amended by revising paragraphs (3) and (6) of subsection (b) and by adding a new subsection to read as follows:

"(3) Upon a finding by an auditor that an audited prescription meets the following criteria:

(A) The pharmaceutical product dispensed is that ordered by the prescriber;

(B) The quantity of product is as ordered by the prescriber;

(C) The dosing of the product is as ordered by the prescriber;

(D) The patient received the dispensed prescription;

(E) The amount collected for the prescription from the patient is the amount adjudicated by electronic transmission or other method by the payor or the payor's agent; and

(F) The amount paid to the dispensing pharmacy is the same as adjudicated to the dispensing pharmacy by electronic transmission or other method by the payor or payor's agent,

Any any clerical or record-keeping error, such as a typographical error, scrivener's error, or computer error, regarding a required document or record may shall not in and of itself constitute fraud or abuse; however, such claims may and shall not be subject to recoupment. No such claim shall be subject to criminal penalties without proof of intent to commit fraud;"

"(6) Each pharmacy and prescription shall be audited under the same standards and parameters as other similarly situated pharmacies, whether local or mail-order, and prescriptions audited by the entity, and with the same frequency;"

"(g) The state shall have the right to independently audit any pharmacy or pharmacist in such pharmacy in which an insurance company or pharmacy benefits manager contracting with the state owns a 10 percent or greater share of said pharmacy. Such independent audit shall be for the purpose of determining if the state is receiving the full amount of contracted rebates to include all funds that pass from the drug product manufacturer or supplier to the insurance company or pharmacy benefits manager."

SECTION 2.

All laws and parts of laws in conflict with this Act are repealed.