Section 356.3 - Appeals process - Dismissal - Fraud or willful misrepresentation - Application of actA. Each entity conducting an audit shall establish a written appeals process under which a pharmacy may appeal an unfavorable preliminary audit report and/or final audit report to the entity.B. Following an appeal, if the entity finds that an unfavorable audit report or any portion thereof is unsubstantiated, the entity shall dismiss the audit report or the unsubstantiated portion of the audit report without any further action.C. Any final audit report, following the final audit appeal period, with a finding of fraud or willful misrepresentation shall be referred to the district attorney having proper jurisdiction or the Attorney General for prosecution upon completion of the appeals process.D. For any audit initiated based on or that involves fraud, willful misrepresentation, or abuse, the auditing entity shall provide, in writing, at the time of the audit, a clear and conspicuous declaration to the pharmacy being audited that the audit is being conducted under suspicion of fraud, willful misrepresentation, or abuse and a statement of facts that supports the reasonable suspicion.E. Any entity conducting an audit that is based on or involves fraud, willful misrepresentation, or abuse shall provide to the Office of the Attorney General:1. Notice at least two (2) calendar days prior to beginning performance of an audit pursuant to this section;2. A preliminary report within thirty (30) calendar days of performing the audit pursuant to this section; and3. A final report within thirty (30) calendar days following the closure of the final appeal period for an audit performed pursuant to this section.F. The Attorney General, authorized employees, and examiners shall have access to any pharmacy benefits manager's files and records that may relate to an audit that is based on or involves fraud, willful misrepresentation, or abuse.G. The Attorney General may levy a civil or administrative fine of not less than One Hundred Dollars ($100.00) and not greater than Ten Thousand Dollars ($10,000.00) for each violation of this section and assess any other penalty or remedy authorized by law.Okla. Stat. tit. 59, § 356.3
Amended by Laws 2024, c. 332,s. 3, eff. 5/22/2024.Amended by Laws 2021 , c. 409, s. 2, eff. 5/4/2021.Added by Laws 2008 , HB 2490, c. 137, §4, eff. 11/1/2008; Amended by Laws 2011 , SB 673, c. 375, §2, eff. 11/1/2011.