Relating to procedures for certain audits of pharmacists and pharmacies.
Additionally, the bill specifies that these procedures only apply to contracts executed or renewed after the effective date of this legislation, preserving existing contracts under previous regulations until their renewal. The bill also includes provisions to enforce compliance with the new auditing standards, ensuring that staff and operational practices align with the legislative intent.
The enactment of HB 1358 would significantly impact the auditing processes within the healthcare sector, specifically for pharmacists and pharmacy benefit managers. It eliminates the ability of these managers to base recoupments on extrapolation techniques, which could potentially lead to more fair assessments during audits. Furthermore, the bill mandates that auditors cannot enter pharmacy areas without proper authorization, enhancing privacy and operational control for pharmacists. These changes are expected to create a more equitable auditing environment that protects the rights of healthcare providers.
House Bill 1358 aims to establish more defined procedures regarding audits conducted by health benefit plan issuers and pharmacy benefit managers on pharmacists and pharmacies. The bill introduces new definitions related to auditing, including 'desk audit' and 'on-site audit', delineating where and how these audits can take place. One of the core components of the bill is to limit the practices of extrapolation in audits, ensuring that recoupment amounts are based solely on final audit reports rather than estimations derived from incomplete reviews of claims.
Some contention exists around the stipulations introduced by HB 1358. Proponents argue that limiting extrapolation is crucial for fair auditing, protecting pharmacists from excessive financial penalties based upon incomplete data. Critics, however, may express concerns regarding the possible reduction in the efficacy of fraud detection practices that rely on broader sampling techniques. Furthermore, while the bill aims to prevent unjust repercussions, balancing a pharmacist's rights with the oversight needed to prevent fraudulent practices continues to be a topic of discussion.