NC H644

Establishes pharmacy audit rights under new Article 4C of Chapter 90, requiring at least 14 days' advance notice for initial on-site audits and limiting audits to 24 months from claim submission date.

Requires audits involving clinical judgment be conducted by a licensed pharmacist employed by or contracted with the auditing entity.

Prohibits deeming clerical, typographical, or computer errors as fraudulent without additional evidence, and prohibits use of extrapolation to calculate recoupments unless required by federal law.

Mandates an internal appeals process for pharmacies to contest unfavorable audit reports, with recoupments only occurring after final disposition unless fraud is reasonably suspected.

Allows Division of Medical Assistance providers 30 working days from receipt of tentative decision notice to submit a written request for Reconsideration Review, effective January 1, 2012 for pharmacy audits.