Sec. 8. An audit finding of an overpayment or underpayment of a claim:
(1) must be based on an actual overpayment or underpayment; and
(2) may not be based on a projection that is based on the number of:
(A) patients who:
(i) have similar diagnoses; and
(ii) are served by the pharmacy; or
(B) prescriptions for or refills of similar legend drugs that are dispensed by the pharmacy.
As added by P.L.7-2009, SEC.1.
Structure Indiana Code
Title 25. Professions and Occupations
Article 26. Pharmacists, Pharmacies, Drug Stores
25-26-22-1. Definitions Applicable to Chapter
25-26-22-3. "Extrapolation Audit"
25-26-22-4.2. Third Party Payer Onsite Audit Limitations
25-26-22-5. Audit Requirements
25-26-22-6. Written Audit Reports
25-26-22-7. Clerical Errors; Fraud; Recoupment of Payment
25-26-22-8. Overpayment and Underpayment Audit Findings
25-26-22-9. Audit Report; Distribution; Interest Accrual
25-26-22-10. Prohibition of Extrapolation Audits for Calculating Recoupments or Penalties
25-26-22-11. Application of Chapter for Investigative Audits