FL S2194

Expands audit requirements to cover third-party payor and third-party administrator audits of pharmacies in addition to Medicaid-related audits, all conducted under uniform standards by licensed pharmacists with at least 1 week's prior notice.

Exempts claims from financial recoupment if they contain only clerical or recordkeeping errors (typographical, scrivener's, or computer errors) and are otherwise valid claims, and prohibits use of extrapolation in calculating penalties or recoupment.

Establishes that audit findings must be based on actual overpayment or underpayment rather than projections, limits audit periods to 1 calendar year, prohibits scheduling audits during the first 5 days of any month, and requires preliminary audit reports within 90 days and final reports within 6 months.

Requires the Agency for Health Care Administration (for Medicaid audits) or third-party payors/administrators (for their respective audits) to establish appeal processes with ad hoc peer review panels of active pharmacists, allowing dismissal of unsubstantiated audit reports without further proceedings.

Specifies that audit criteria apply to Medicaid claims submitted after July 11, 2003, and third-party claims submitted after July 1, 2009; excludes investigative audits by the Medicaid Fraud Control Unit and AHCA fraud investigations from these requirements.