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20-77-126. Relation to Arkansas Pharmacy Audit Bill of Rights.
Arkansas Code — all titles (historical 2020) · legal_authorities
20-77-126. Relation to Arkansas Pharmacy Audit Bill of Rights.
(a) From and after the date that a state plan amendment submitted under § 20-77-125 is approved by the Centers for Medicare & Medicaid Services, § 20-77-125 shall supersede and replace § 17-92-1201(f) with regard to Medicaid integrity audits of pharmacies and pharmacists, but all other subsections of § 17-92-1201 shall continue in full force and effect with regard to Medicaid integrity audits.
(b) Section 17-92-1201 is not affected by § 20-77-125 with regard to audits conducted by or on behalf of a person or entity other than Medicaid integrity audits under subsection (a) of this section.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 20-77-126
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Stable record: arkansas_code:legal_authorities:20-77-126
Source file: gov.ar.code.title.20.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 71064f138abc9155f9b2913576b2db46bf69598ff2505c764a5dc5e19ce11372
Source location: content.xml paragraph 35766
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20-77-126. Relation to Arkansas Pharmacy Audit Bill of Rights.
(a) From and after the date that a state plan amendment submitted under § 20-77-125 is approved by the Centers for Medicare & Medicaid Services, § 20-77-125 shall supersede and replace § 17-92-1201(f) with regard to Medicaid integrity audits of pharmacies and pharmacists, but all other subsections of § 17-92-1201 shall continue in full force and effect with regard to Medicaid integrity audits.
(b) Section 17-92-1201 is not affected by § 20-77-125 with regard to audits conducted by or on behalf of a person or entity other than Medicaid integrity audits under subsection (a) of this section.
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Arkansas Code — all titles (historical 2020) · legal_authorities
17-92-1201. Arkansas Pharmacy Audit Bill of Rights.
(a) This subchapter shall be known and may be cited as the “Arkansas Pharmacy Audit Bill of Rights”.
(b) Notwithstanding any other law, when an audit of the records of a pharmacy is conducted by a managed-care company, an insurance company, a third-party payor, or any entity that represents responsible parties such as companies or groups, the audit shall be conducted in accordance with the following bill of rights:
(1) The entity conducting the initial on-site audit shall give the pharmacy notice at least one (1) week before conducting the initial on-site audit for each audit cycle;
(2) Any audit that involves clinical or professional judgment shall be conducted by or in consultation with a pharmacist;
(3)(A)(i) Any clerical or recordkeeping error, such as a typographical error, scrivener's error, or computer error, regarding a required document or record shall not in and of itself constitute fraud.
(ii) However, a claim arising under subdivision (b)(3)(A)(i) of this section may be subject to recoupment.
(B) A claim arising under subdivision (b)(3)(A)(i) of this section is not 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 for 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;
(5)(A) A finding of an overpayment or underpayment may be a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs.
(B) However, recoupment of claims under subdivision
Source: Arkansas Code — historical release 78 (November 6, 2020) · 17-92-1201
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 17-92-1201. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
20-77-125. Contingency fee audits prohibited — Definitions.
(a) As used in this section:
(1) “Healthcare provider” means a person enrolled to provide health or medical care services or goods authorized under Medicaid;
(2) “Medicaid” means the medical assistance program provided in this state under Title XIX of the Social Security Act of 1965, 42 U.S.C. § 1396 et seq., including components of the program;
(3) “Medicaid integrity audit contract” means a contract required under federal law between the Department of Human Services and a Medicaid integrity audit program contractor to:
(A) Review the actions of healthcare providers furnishing services or goods for which payment may be made under the Arkansas Medicaid Program to determine whether fraud, waste, or abuse has occurred or is likely to occur, or whether fraud, waste, or abuse has the potential for resulting in an expenditure of Medicaid funds that is not intended under the Arkansas Medicaid Program;
(B) Audit Medicaid claims to ensure proper payments were made; or
(C) Identify overpayments made to individuals or entities receiving Medicaid funds; and
(4) “Person” means any individual, company, firm, organization, association, corporation, or other legal entity.
(b) The Division of Medical Services of the Department of Human Services shall not enter into a Medicaid integrity audit contract that authorizes all or part of an auditor's compensation to be based, directly or indirectly, on the amount of overpayments identified or collected by the auditor.
(c)(1) Within forty-five (45) days after April 11, 2013, the division shall seek a waiver from the Centers for Medicare & Medicaid Services of the requirement that recovery audit contractors, as identified in 42 U.S.C. § 1396a(a)(42)(B), be paid on a
Source: Arkansas Code — historical release 78 (November 6, 2020) · 20-77-125
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 20-77-125. This identifies an authority to review, not proof of applicability.