Missouri Revised Statutes
Chapter 338 - Pharmacists and Pharmacies
Section 338.600 - Criteria for audit — appeals process to be established — report to be provided — applicability exceptions.

Effective - 28 Aug 2008
338.600. Criteria for audit — appeals process to be established — report to be provided — applicability exceptions. — 1. Notwithstanding any other provision of law to the contrary, when an audit of the records of a pharmacy licensed in this state is conducted by a managed care company, insurance company, third-party payor, or any entity that represents such companies or groups, such audit shall be conducted in accordance with the following:
(1) The entity conducting the initial on-site audit shall provide the pharmacy with notice at least one week prior to conducting the initial on-site audit for each audit cycle;
(2) Any audit which involves clinical judgment shall be conducted by or in consultation with a licensed pharmacist;
(3) Any clerical error, record-keeping error, typographical error, or scrivener's error regarding a required document or record shall not constitute fraud or grounds for recoupment, so long as the prescription was otherwise legally dispensed and the claim was otherwise materially correct; except that, such claims may be otherwise subject to recoupment of overpayments or payment of any discovered underpayment. No claim arising under this subdivision shall be subject to criminal penalties without proof of intent to commit fraud;
(4) A pharmacy may use the records of a hospital, physician, or other authorized practitioner of the healing arts involving drugs or medicinal supplies written or transmitted by any means of communication for purposes of validating the pharmacy record with respect to orders or refills of a legend or narcotic drug. Electronically stored images of prescriptions, electronically created annotations and other related supporting documentation shall be considered valid prescription records. Hard copy and electronic signature logs that indicate the delivery of pharmacy services shall be considered valid proof of receipt of such services by a program enrollee;
(5) A finding of an overpayment or underpayment may be a projection based on the number of patients served and having a similar diagnosis or on the number of similar orders or refills for similar drugs; except that, recoupment of claims shall be based on the actual overpayment or underpayment unless the projection for overpayment or underpayment is part of a settlement as agreed to by the pharmacy;
(6) Each pharmacy shall be audited under the same standards and parameters as other pharmacies audited by the entity;
(7) A pharmacy shall be allowed at least thirty days following receipt of the preliminary audit report in which to produce documentation to address any discrepancy found during an audit;
(8) The period covered by the audit shall not exceed a two-year period beginning two years prior to the initial date of the on-site portion of the audit unless otherwise provided by contractual agreement or if there has been a previous finding of fraud or as otherwise provided by state or federal law;
(9) An audit shall not be initiated or scheduled during the first three business days of any month due to the high volume of prescriptions filled during such time unless otherwise consented to by the pharmacy;
(10) The preliminary audit report shall be delivered to the pharmacy within one hundred twenty days after conclusion of the audit, with reasonable extensions permitted. A final audit report shall be delivered to the pharmacy within six months of receipt by the pharmacy of the preliminary audit report or final appeal, as provided for in subsection 3 of this section, whichever is later;
(11) Notwithstanding any other provision in this subsection, the entity conducting the audit shall not use the accounting practice of extrapolation in calculating recoupments or penalties for audits, except as otherwise authorized under subdivision (5) of this subsection.
2. Recoupments of any disputed moneys shall only occur after final internal disposition of the audit, including the appeals process set forth in subsection 3 of this section. Should the identified discrepancy for an individual audit exceed twenty-five thousand dollars, future payments to the pharmacy in excess of twenty-five thousand dollars may be withheld pending finalization of the audit.
3. Each entity conducting an audit shall establish an appeals process, lasting no longer than six months, under which a licensed pharmacy may appeal an unfavorable preliminary audit report to the entity. If, following such appeal, the entity finds that an unfavorable audit report or any portion thereof is unsubstantiated, the entity shall dismiss the audit report or such portion without the necessity of any further proceedings.
4. Each entity conducting an audit shall provide a copy of the final audit report, after completion of any appeal process, to the plan sponsor.
5. This section shall not apply to any investigative audit that involves probable fraud, willful misrepresentation, or abuse.
6. This section shall not apply to any audit conducted as part of any inspection or investigation conducted by any governmental entity or law enforcement agency.
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(L. 2008 S.B. 1068)

Structure Missouri Revised Statutes

Missouri Revised Statutes

Title XXII - Occupations and Professions

Chapter 338 - Pharmacists and Pharmacies

Section 338.010 - Practice of pharmacy defined — auxiliary personnel — written protocol required, when — nonprescription drugs — rulemaking authority — therapeutic plan requirements — veterinarian defined — additional requirements — ShowMeVax system,...

Section 338.013 - Pharmacy technician to register with board of pharmacy, fees, application, renewal — refusal to issue, when — employee disqualification list maintained, use.

Section 338.015 - Patient's freedom of choice to obtain prescription services, waiver — consultation and advice.

Section 338.020 - Application for license — requirements — examination — oath — penalty — military service, effect of.

Section 338.030 - Applicant — requirements for qualification.

Section 338.035 - Application, contents — intern pharmacist — board shall promulgate rules, procedure.

Section 338.040 - License issued without examination, when — reciprocity — equivalency examination — fees.

Section 338.043 - Temporary license — eligibility — renewal.

Section 338.050 - Pharmacist license, issued when, period covered.

Section 338.055 - Denial, revocation or suspension of license, grounds for — expedited procedure — temporary authority, when.

Section 338.056 - Generic substitutions, when, requirements — violations, penalty.

Section 338.059 - Prescriptions, how labeled.

Section 338.060 - Renewal of license or permit — late renewal or failure to renew, effect — continuing education requirements — inactive license issued when — changed to active, procedure.

Section 338.065 - Disciplinary hearings — grounds for discipline.

Section 338.067 - Revocation and restoration of license — conditions.

Section 338.070 - Fees, amount, how set, collection, disposition — fund, created, use, funds transferred to general revenue, when.

Section 338.075 - Adverse actions against licensee, notification to board of pharmacy, when — rulemaking authority.

Section 338.080 - Display of license or renewal required.

Section 338.085 - Interchangeable biological products, pharmacist may dispense as substitute, when — recordkeeping — rulemaking authority.

Section 338.090 - Sale of poisons — regulations.

Section 338.095 - Prescription, drug order, defined — telephone prescription, defined — prescription and medical information may be provided, when.

Section 338.100 - Records required to be kept — requirements.

Section 338.110 - Board of pharmacy, members, qualifications, terms.

Section 338.120 - Board of pharmacy — organization.

Section 338.130 - Compensation of board members, personnel.

Section 338.132 - Board of pharmacy, salary schedule for employees to be established.

Section 338.140 - Board of pharmacy, powers, duties — advisory committee, appointment, duties — letters of reprimand, censure or warning.

Section 338.142 - Drug take-back program, board authorized to expend, allocate, or award funds.

Section 338.143 - Technology assisted verification or remote medication dispensing, pilot or demonstration research project authorized — definitions — requirements — expiration date — report.

Section 338.145 - Board president may administer oaths and issue subpoenas — enforcement of subpoenas.

Section 338.150 - Inspections by authorized representatives of board, where — testing program authorized — rulemaking authority.

Section 338.155 - Immunity from civil liability, when.

Section 338.165 - Class B pharmacies subject to department inspection, when — definitions — rulemaking authority — certificate of medication therapeutic plan authority required, when — dispensing of medications, requirements — advisory committee.

Section 338.170 - Title of pharmacist — used by whom.

Section 338.180 - Prosecution of offenders.

Section 338.185 - Board has access to certain court records.

Section 338.190 - Violation of law by licensee — penalty.

Section 338.195 - Violation of law by person not licensed — penalty.

Section 338.196 - Prescription by practitioner licensed in another state, may be filled, requirement.

Section 338.198 - Pharmacist may fill prescription forwarded by authorized agent.

Section 338.200 - Pharmacist may dispense emergency prescription, when, requirements — rulemaking authority.

Section 338.202 - Maintenance medications, pharmacist may exercise professional judgment on quantity dispensed, when.

Section 338.205 - Opioid antagonist, storage and dispensing of without a license, when.

Section 338.210 - Pharmacy defined — practice of pharmacy to be conducted at pharmacy location — rulemaking authority.

Section 338.215 - Remote dispensing site pharmacy — definitions — requirements — supervision — location — staffing — license required, when — rulemaking authority.

Section 338.220 - Operation of pharmacy without permit or license unlawful — application for permit, classifications, fee — duration of permit.

Section 338.230 - Disposition of fees.

Section 338.240 - Evidence required for issuance of permit — veterinary permit pharmacy, designation of supervising registered pharmacist, when.

Section 338.250 - Equipment required — manner of operation of pharmacy — compliance with state and federal laws required.

Section 338.255 - Specific prescription or nonprescription drugs or devices, no requirement to carry.

Section 338.260 - Business name not to include certain words unless supervised by pharmacist — historical names permitted — board of pharmacy may enforce — remote dispensing site pharmacy, physical presence of pharmacist not required, when.

Section 338.270 - Renewal applications to be made, when.

Section 338.280 - Board of pharmacy, rules and regulations.

Section 338.285 - Board may file complaint, when, where filed.

Section 338.290 - Appeals from decision of board, notice of right.

Section 338.300 - Permit to be posted — not transferable.

Section 338.310 - Violation, a misdemeanor.

Section 338.314 - Inspection of pharmacy within certain facilities authorized — applicability of law.

Section 338.315 - Receipt of drugs from unlicensed source, unlawful — penalty — pharmacy-to-pharmacy transfers, limit — legend drugs, inventories and records — rulemaking authority.

Section 338.320 - Committee established, purpose, members, duties — sunset provision.

Section 338.330 - Definitions.

Section 338.333 - License required, temporary licenses may be granted — out-of-state distributors, reciprocity allowed, when.

Section 338.335 - Separate licenses required, when — exemptions.

Section 338.337 - Out-of-state distributors, licenses required, exception.

Section 338.340 - Sale of drugs, out-of-state distributor, license required.

Section 338.343 - Records to be maintained and be available for board inspection.

Section 338.347 - Renewal of license, application.

Section 338.350 - Board of pharmacy to promulgate rules and regulations — procedure.

Section 338.353 - Discipline of licensee, grounds — procedure — administrative hearing commission to conduct hearing.

Section 338.357 - Sanction imposed by board, when.

Section 338.360 - Inspection of premises allowed, when.

Section 338.365 - Injunction may be issued, when, procedure.

Section 338.370 - Penalties.

Section 338.380 - Refusal to issue a certificate, when — impaired license committee authorized, duties, procedures.

Section 338.400 - Standard of care, definitions, rules.

Section 338.500 - Gross retail prescriptions, tax imposed, definitions.

Section 338.505 - Formula for tax liability, rulemaking authority, appeals procedure.

Section 338.510 - Records to be maintained, form — report of gross receipts, information — confidentiality of information.

Section 338.515 - Effective date of tax.

Section 338.520 - Calculation of tax liability — notification to pharmacies — quarterly adjustment authorized.

Section 338.530 - Offset against Medicaid payments due by pharmacy permitted, when.

Section 338.535 - Remittance to department — pharmacy reimbursement allowance fund created.

Section 338.540 - Notice requirements — unpaid or delinquent taxes, procedure for collection — failure to pay taxes, effect of.

Section 338.550 - Expiration date of tax, when.

Section 338.600 - Criteria for audit — appeals process to be established — report to be provided — applicability exceptions.

Section 338.650 - Fund established, use of moneys.

Section 338.665 - Nicotine replacement therapy product, defined — prescribing and dispensing, rulemaking authority.

Section 338.700 - Definitions.

Section 338.710 - Program created, goal — authority of board — evaluation report — expiration date.

Section 338.730 - HIV postexposure prophylaxis, dispensing of, requirements — definitions — rulemaking authority.