The Florida legislature is currently considering proposed legislation that may affect the way in which managed care organizations, insurers, third-party payors, pharmacy benefit managers and other entities audit pharmacies in Florida. The Florida House of Representatives, Health Innovation Subcommittee, is reviewing HB 745, which proposes to create a “Pharmacy audit bill of rights.” The Health Policy Committee of the Florida Senate considered a similar bill, CS/SB 702, titled “Pharmacy audits; rights.” Both bills set forth specific time periods for providing notice of on-site audits, for conducting on-site audits, and for providing preliminary and final reports. The bills require payment of pharmacy claims that were retroactively denied for clerical errors if the prescriptions were dispensed correctly unless there is a pattern of errors or allegations of fraudulent billing. The bills do not apply to audits related to suspected fraudulent activity or fee-for-service claims under the Medicaid program.
The bills vary dramatically, however, on their enforcement mechanisms. HB 745 allows for a private cause of action for willful violations of the law, including the potential to recover treble damages and an award of attorneys’ fees. CS/SB 702 does not provide a private cause of action. Rather, it requires the Florida Office of Insurance Regulation to investigate complaints of willful violations and deems a violation of the audit rights as an unfair claim settlement practice.