FL H1149

Expands audit provisions to include third-party payor and third-party administrator audits of pharmacies, in addition to Medicaid-related audits, with the same procedural requirements.

Exempts claims containing clerical or recordkeeping errors (typographical, scrivener's, or computer errors) from financial recoupment if the claim is otherwise valid, and prohibits criminal penalties without proof of intent to commit fraud.

Prohibits use of extrapolation accounting practices for calculating penalties or recoupment in Medicaid, third-party payor, and third-party administrator audits.

Applies audit criteria to Medicaid claims submitted after July 11, 2003, and to third-party claims submitted after July 1, 2009; requires audit periods not to exceed 1 calendar year and audits not to be scheduled during the first 5 days of any month.

Establishes procedures for preliminary review and appeals through peer review panels consisting of active pharmacists, allowing pharmacists to challenge unfavorable audit reports without legal counsel; requires final audit reports within 6 months of preliminary report or appeal.