(a) Nothing in this chapter shall apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other third-party payer has indications that support a reasonable suspicion that criminal wrongdoing, willful misrepresentation, fraud, or abuse has occurred.

(b) Nothing in this chapter shall apply to an audit conducted by, or at the direction of, the California State Board of Pharmacy, the State Department of Health Care Services, the State Department of Public Health, or the Medicare program.

Terms Used In California Business and Professions Code 4431

  • board: means any entity listed in Section 101, the entities referred to in Sections 1000 and 3600, the State Bar, the Department of Real Estate, and any other state agency that issues a license, certificate, or registration authorizing a person to engage in a business or profession. See California Business and Professions Code 31
  • Fraud: Intentional deception resulting in injury to another.
  • State: means the State of California, unless applied to the different parts of the United States. See California Business and Professions Code 21

(Added by Stats. 2012, Ch. 706, Sec. 1. (SB 1195) Effective January 1, 2013.)

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