Montana § 33-2-2005 Prohibitions -- Recoupment -- Payment -- Interest

Montana Statutes

§ 33-2-2005 — Prohibitions -- Recoupment -- Payment -- Interest

Montana·Title 33 INSURANCE AND INSURANCE COMPANIES·Ch. 2 REGULATION OF INSURANCE COMPANIES·Part 20 Pharmacy Audit Integrity Act

33-2-2005 . (Temporary) Prohibitions -- recoupment -- payment -- interest. An entity conducting an audit may not:

(1)include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;

(2)recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener's errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;

(3)collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentat

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33-2-2005 . (Temporary) Prohibitions -- recoupment -- payment -- interest. An entity conducting an audit may not:
(1) include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;
(2) recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener's errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;
(3) collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentation that is evidenced by the review of claims data, statements, physical review, or other investigative methods;
(4) use extrapolation or other statistical expansion techniques in calculating the amount of any recoupment or penalty;
(5) pay the agent or employee who conducted the audit based on a percentage of the amount recovered;
(6) charge interest during the audit period; or
(7) recoup funds on the basis of the timing of purchases of dispensed medication but instead shall permit a pharmacy to use drug purchase records without limitation of date or source to validate the dispensing of legend or narcotic drugs so long as the purchase of the drug was done in accordance with state or federal law. (Terminates June 30, 2029--sec. 8, Ch. 474, L. 2025.)

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