Montana Code 33-2-2005. Prohibitions — recoupment — payment — interest
33-2-2005. Prohibitions — recoupment — payment — interest. An entity conducting an audit may not:
Terms Used In Montana Code 33-2-2005
- Audit: means a review of the records of a pharmacy by or on behalf of an entity that finances or reimburses the cost of health care services or pharmaceutical products. See Montana Code 33-2-2002
- Entity: includes :
(a)a pharmacy benefits manager;
(b)a health benefit plan;
(c)a third-party administrator; and
(d)a company, group, or agent that represents or is engaged by one of the entities described in this subsection (2). See Montana Code 33-2-2002
(1)include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;
(2)recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener’s errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;
(3)collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentation that is evidenced by the review of claims data, statements, physical review, or other investigative methods;
(4)use extrapolation or other statistical expansion techniques in calculating the amount of any recoupment or penalty;
(5)pay the agent or employee who conducted the audit based on a percentage of the amount recovered; or
(6)charge interest during the audit period.