Bill > S0314

This bill amends existing Rhode Island pharmacy audit regulations by introducing several key protections for pharmacists during insurance company audits. The legislation limits insurers and their intermediaries to conducting only one audit per pharmacy every twelve months, with exceptions allowed if fraud or misrepresentation is reasonably suspected. The bill establishes detailed procedural requirements for audits, including providing advance notice, restricting the number of prescription claims examined, establishing a clear appeals process, and mandating specific timelines for audit reporting. Important protections include prohibiting auditors from being paid based on audit findings, allowing pharmacists to use scanned prescription images during audits, and preventing penalties for simple clerical or typographical errors without proven intent to commit fraud. Significantly, the bill empowers the Rhode Island attorney general to impose fines, penalties, or other sanctions for non-compliance, thereby providing a enforcement mechanism to ensure insurers follow these new audit guidelines. The bill aims to create a more fair and transparent audit process that protects pharmacists from overly burdensome or punitive audit practices while still maintaining mechanisms to investigate genuine cases of fraud or misconduct.

Health and Social Services

https://status.rilegislature.gov/