ND HB1418

Entities conducting pharmacy audits must provide at least 14 business days' written notice before initial onsite audits and must employ or contract with a licensed pharmacist if the audit involves clinical or professional judgment.

Audits are limited to claims no more than 24 months old from submission or adjudication date, cannot be conducted during the first five business days of the month, and must occur outside patient care areas.

Recoupments must be based on actual overpayments only, without extrapolation or projections; dispensing fees cannot be included unless no prescription was dispensed, and entities cannot receive payment based on a percentage of recovered amounts.

Preliminary audit reports must be delivered within 120 days of audit conclusion; pharmacies have 60 days to respond; final reports must be issued within 90 days; recoupments cannot be assessed until appeals are exhausted and final reports issued.

The law does not apply to fraud investigations, state Medicaid programs, or claims adjudicated before August 1, 2011, and violations constitute a class B misdemeanor.