Rhode Island 2024 Regular Session

Rhode Island Senate Bill S2605

Introduced
3/1/24  

Caption

Restricts audits of pharmacists conducted by insurers and their intermediaries, limiting audits to 1 per year unless fraud or misrepresentation is reasonably suspected. The Rhode Island attorney would have the authority to impose sanctions for violations.

Impact

The bill will amend existing regulations to establish a more structured auditing framework. Under S2605, auditors will be required to provide advance notice of audits and conduct them according to specified procedures, including restrictions on the extrapolation of data when assessing payment discrepancies. The attorney general would also be empowered to impose sanctions for violations of the auditing regulations, strengthening oversight and enhancing accountability in the auditing process. The aim is to create a more balanced relationship between pharmacies and insurers, fostering a fairer operating environment.

Summary

Bill S2605 is a significant piece of legislation that relates to the regulation of pharmacy audits conducted by insurers and their intermediaries. The primary aim of the bill is to limit the frequency of audits imposed on pharmacies to once per year, unless there is reasonable suspicion of fraud or misrepresentation. This change aims to provide relief to pharmacies from what is often seen as excessive auditing practices, which can disrupt their operations and financial stability. By instituting guidelines around the auditing process, S2605 seeks to protect pharmacists while ensuring compliance with regulatory standards.

Contention

While proponents of the bill argue that it represents a necessary reform to protect pharmacies from arbitrary audit practices, there may be contention regarding the balance between oversight and operational freedom. Stakeholders concerned about fraud prevention might argue that limiting audits could enable fraudulent activities, thereby affecting the integrity of pharmacy operations and reimbursement processes. The debate is likely to center around the fine line between protecting pharmacy interests and ensuring rigorous oversight to prevent misuse of resources within the healthcare system.

Companion Bills

No companion bills found.

Previously Filed As

RI S0991

Rhode Island Public Transit Authority

RI H5678

The Rhode Island Health Care Reform Act Of 2004 -- Health Insurance Oversight

RI H5076

Rhode Island Physical Therapist Licensure Compact Act

RI S0580

Rhode Island Physical Therapist Licensure Compact Act

RI H5486

The Rhode Island Cannabis Act

RI S0566

The Rhode Island Health Care Reform Act Of 2004 -- Health Insurance Oversight

RI H5839

Rhode Island Business Corporation Act

RI H5495

The Rhode Island Health Care Reform Act Of 2004 -- Health Insurance Oversight

RI H6001

Rhode Island Public Transit Authority

RI S1093

Rhode Island Public Transit Authority

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