Section 34-23-180 – Short Title.

Section 34-23-180 Short title. This article shall be known and may be cited as “The Pharmacy Audit Integrity Act.” (Act 2012-306, p. 668, §1.)

Section 34-23-181 – Definitions.

Section 34-23-181 Definitions. The following words shall have the following meanings as used in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care insurer, health maintenance organization, accident […]

Section 34-23-182 – Purpose.

Section 34-23-182 Purpose. The purpose of this article is to establish minimum and uniform standards and criteria for the audit of pharmacy records by or on behalf of certain entities. (Act 2012-306, p. 668, §3.)

Section 34-23-183 – Application.

Section 34-23-183 Application. This article shall apply to any audit of the records of a pharmacy conducted by a managed care company, nonprofit hospital or medical service organization, health benefit plan, third-party payor, pharmacy benefit manager, a health program administered by a department of the state, except the Alabama Medicaid Agency, or any entity that […]

Section 34-23-184 – Audit Procedures; Report.

Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall follow these procedures: (1) The pharmacy contract shall identify and describe in detail the audit procedures. (2) The entity conducting the on-site audit shall give the pharmacy written notice at least two weeks before conducting the initial on-site audit for each audit cycle. […]

Section 34-23-185 – Appeals.

Section 34-23-185 Appeals. (a) Each entity conducting an audit shall establish a written appeals process under which a pharmacy may appeal an unfavorable preliminary audit report to the entity. (b) Following the appeal, if the entity finds that an unfavorable audit report or any portion thereof is unsubstantiated, the entity shall dismiss the audit report […]

Section 34-23-186 – Extrapolation.

Section 34-23-186 Extrapolation. (a) The auditing entity shall not use extrapolation to calculate penalties or amounts to be charged back or recouped unless otherwise required by federal requirements or federal plans. (b) The auditing entity conducting a pharmacy audit shall not compensate an employee or contractor with which an auditing entity contracts to conduct a […]

Section 34-23-187 – Fraud, Willful Misrepresentation, or Waste Abuse.

Section 34-23-187 Fraud, willful misrepresentation, or waste abuse. This article does not apply to any audit, review, or investigation that involves alleged fraud, willful misrepresentation, or waste abuse. (Act 2012-306, p. 668, §8.)