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304.17A-741 Audit of pharmacy records -- Conditions.
When an audit of the records of a pharmacy is conducted by an auditing entity, it shall be <br>subject to the following conditions: <br>(1) The auditing entity shall give at least thirty (30) days' written notice to the pharmacy
prior to conducting the audit for each audit to be conducted;
(2) An audit performed by the auditing entity that involves clinical or professional
judgment shall be conducted in consultation with a pharmacist;
(3) A pharmacy may use the records of a hospital, physician, or other practitioner as
defined in KRS 217.015(35), or transmitted by any means of communication, for <br>purposes of validating pharmacy records with respect to orders or refills of a drug;
(4) The recoupment of claims shall be based on the actual overpayment or
underpayment of claims unless the pharmacy agrees to a settlement to the contrary;
(5) A pharmacy shall be audited under the same standards and parameters as other
similarly situated pharmacies audited by the auditing entity;
(6) The period covered by the audit shall not exceed two (2) years from the date the
claim was submitted for payment except if a longer period is allowed by federal law <br>or if there is evidence of fraud;
(7) An audit shall not be scheduled during the first seven (7) calendar days of any
month, unless consented to by the pharmacy;
(8) A preliminary audit report shall be delivered to the pharmacy within one hundred
twenty (120) days after the exit interview;
(9) A final audit report shall be delivered to the pharmacy within six (6) months after
receipt of the preliminary audit report or after all appeals have been exhausted, <br>whichever is later;
(10) The auditing entity shall allow a pharmacy at least thirty (30) days following receipt
of the preliminary audit report to produce documentation to address any <br>discrepancies found during an audit;
(11) The final audit report shall provide claim-level detail of the amounts and reasons for
each claim recovery found due. If no amounts have been found due, the final audit <br>report shall so state;
(12) The auditing entity shall not receive payment based on a percentage of the amount
recovered in an audit; and
(13) The auditing entity shall conduct an exit interview at the close of the audit. The exit
interview shall be conducted at a time agreed to by the audited pharmacy. The <br>interview shall provide the audited pharmacy an opportunity to: <br>(a) Respond to questions from the auditing entity; <br>(b) Review and comment on the initial findings of the auditing entity; and <br>(c) Provide additional documentation to clarify the initial findings of the auditing
entity.
Effective: June 25, 2009 <br>History: Created 2009 Ky. Acts ch. 76, sec. 2, effective June 25, 2009.
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