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Current as of January 01, 2024 | Updated by Findlaw Staff
An entity conducting an audit may not:
(1) include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;
(2) recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener's errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;
(3) collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentation that is evidenced by the review of claims data, statements, physical review, or other investigative methods;
(4) use extrapolation or other statistical expansion techniques in calculating the amount of any recoupment or penalty;
(5) pay the agent or employee who conducted the audit based on a percentage of the amount recovered; or
(6) charge interest during the audit period.
Cite this article: FindLaw.com - Montana Title 33. Insurance and Insurance Companies § 33-2-2005. Prohibitions--recoupment--payment--interest - last updated January 01, 2024 | https://codes.findlaw.com/mt/title-33-insurance-and-insurance-companies/mt-st-33-2-2005/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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