Georgia Code
Article 6 - Pharmacies
§ 26-4-118. Pharmacy Audit Bill of Rights; Recoupment of Disputed Funds; Appeals Process for Unfavorable Reports; Final Audit Report; Investigative Audits Based on Criminal Offenses

Notwithstanding any other provision in this subsection, the agency conducting the audit shall not use the accounting practice of extrapolation in calculating recoupments or penalties for audits.
History. Code 1981, § 26-4-118 , enacted by Ga. L. 2006, p. 198, § 1/HB 1371; Ga. L. 2009, p. 8, § 26/SB 46; Ga. L. 2013, p. 615, § 1/HB 179; Ga. L. 2015, p. 337, § 1/HB 470; Ga. L. 2016, p. 864, § 26/HB 737; Ga. L. 2017, p. 219, § 1/HB 206; Ga. L. 2020, p. 654, § 2/HB 918.
The 2013 amendment, effective July 1, 2013, substituted the present provisions of paragraph (b)(3) for the former provisions, which read: “Any clerical or record-keeping error, such as a typographical error, scrivener’s error, or computer error, regarding a required document or record may not in and of itself constitute fraud; however, such claims may be subject to recoupment. No such claim shall be subject to criminal penalties without proof of intent to commit fraud”; added paragraph (b)(4); redesignated former paragraphs (b)(4) through (b)(6) as present paragraphs (b)(5) through (b)(7), respectively; deleted former paragraph (b)(7), which read: “A pharmacy shall be allowed at least 30 days following receipt of the preliminary audit report in which to produce documentation to address any discrepancy found during an audit;”; in subsection (d), substituted “shall have at least 30 days from the delivery of the preliminary audit report to appeal” for “may appeal” in the first sentence, and substituted “such portion” for “said portion” in the second sentence; and added subsection (g).
The 2015 amendment, effective July 1, 2015, in subsection (b), in the introductory language, inserted “pharmacy benefits manager, any entity licensed by the Department of Insurance,” near the middle and inserted “or a private person bringing a claim pursuant to Article 7B of Chapter 4 of Title 49,” near the end; in paragraph (b)(1), substituted “14 days” for “one week” near the middle and inserted “and include in such notice a comprehensive list of claims by prescription number to be audited, although the final two digits may be omitted” near the end; in paragraph (b)(3), substituted “shall not” for “may not” in the first sentence, and substituted “though recoupment shall be limited to the amount overpaid” for “underpayment, or improper dispensing of drugs or medicinal supplies.” at the end; in paragraph (b)(8), inserted “pharmacy benefits manager, any entity licensed by the Department of Insurance,” near the middle and deleted “or” following “Title 49,” near the end; inserted “internal” in the first sentence in subsection (d); inserted “at its request or in an alternate format” in subsection (e); inserted a comma following “abuse” in subsection (f); and added subsections (h) and (i).
The 2016 amendment, effective May 3, 2016, part of an Act to revise, modernize, and correct the Code, substituted “Title 49, or any” for “Title 49, any” near the end of paragraph (b)(8).
The 2017 amendment, effective July 1, 2017, added the proviso at the end of subsection (g).
The 2020 amendment, effective January 1, 2021, rewrote subsection (b); substituted “commenced based upon an articulable suspicion of” for “which involves” near the beginning of subsection (f); deleted “paragraph (3) of subsection (b) of” preceding “this Code section” at the beginning of subsection (g); and substituted the present provisions of subsection (i) for the former provisions, which read: “The Commissioner of Insurance shall have enforcement authority over this Code section and shall have the authority granted pursuant to Chapter 64 of Title 33, relating to the regulation and licensure of pharmacy benefits managers.

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