The bill amends Section 5-19.1-35 of the General Laws concerning audits of pharmacies by insurers and their intermediaries. Key provisions include that a pharmacy shall not be subject to more than one on-site audit in connection with a carrier every twelve (12) months, unless there is an identified problem or fraud or misrepresentation is suspected. The bill specifies that audits must be based on actual overpayments or underpayments rather than projections, and auditors cannot use extrapolation unless mandated by law. Pharmacies must receive a fourteen-day advance notice before an audit, and the number of prescriptions involved in the audit is limited to 150. Additionally, a preliminary audit report must be provided within 60 days of the audit's conclusion, and pharmacies have 30 days to address discrepancies. The bill also clarifies that clerical errors do not constitute willful violations.

Furthermore, the bill grants the Rhode Island health insurance commissioner the authority to enforce compliance with these audit regulations. The act will take effect upon passage.

Statutes affected:
5248: 5-19.1-35
5248  SUB A: 5-19.1-35