Bill > S0314

This bill amends Rhode Island's pharmacy audit regulations by establishing new rules for how insurance carriers and their intermediaries can conduct audits of pharmacies. The bill limits insurers to conducting only one on-site audit per pharmacy per year, unless there is a reasonable suspicion of fraud, waste, abuse, or intentional misconduct. The legislation provides detailed protections for pharmacies during these audits, including requiring 14 days advance notice, limiting the number of prescription claims examined, establishing a clear appeals process, and mandating that preliminary and final audit reports be delivered within specific timeframes. Auditors are prohibited from being paid based on their audit findings, and they must base overpayment determinations on actual overpayments rather than projections. The bill also specifies that minor clerical or technical errors do not constitute willful violations, and it grants the Rhode Island Attorney General the authority to enforce these audit regulations. Importantly, the new rules aim to create a more balanced and fair audit process that protects pharmacies from excessive or punitive audit practices while still allowing for investigations of potential fraud or misconduct.

Health and Social Services

https://status.rilegislature.gov/