{"data":{"id":"us-ky/krs-304.17a-741","jurisdiction":"us-ky","citation":"KRS 304.17A-741","heading":"Audit of pharmacy records -- Conditions.","body":"When an audit of the records of a pharmacy is conducted by an auditing entity, it shall be\nsubject to the following conditions:\n(1) The auditing entity shall give at least thirty (30) days' written notice to the pharmacy\nprior to conducting the audit for each audit to be conducted;\n(2) An audit performed by the auditing entity that involves clinical or professional\njudgment shall be conducted in consultation with a pharmacist;\n(3) A pharmacy may use the records of a hospital, physician, or other practitione r as\ndefined in KRS 217.015(35), or transmitted by any means of communication, for\npurposes of validating pharmacy records with respect to orders or refills of a drug;\n(4) An auditing entity shall not require a pharmacy to keep records for a period of time\nlonger than two (2) years, or as required by state or federal law or regulation;\n(5) The recoupment of claims shall be based on the actual overpayment or\nunderpayment of claims unless the pharmacy agrees to a settlement to the contrary;\n(6) A pharmacy sha ll be audited under the same standards and parameters as other\nsimilarly situated pharmacies audited by the auditing entity;\n(7) The period covered by the audit shall not exceed two (2) years from the date the\nclaim was submitted for payment except if a longer period is allowed by federal law\nor if there is evidence of fraud;\n(8) An audit shall not be scheduled during the first seven (7) calendar days of any\nmonth, unless consented to by the pharmacy;\n(9) A preliminary audit report shall be delivered to the  pharmacy within one hundred\ntwenty (120) days after the exit interview;\n(10) A final audit report shall be delivered to the pharmacy within six (6) months after\nreceipt of the preliminary audit report or after all appeals have been exhausted,\nwhichever is later;\n(11) The auditing entity shall allow a pharmacy at least thirty (30) days following receipt\nof the preliminary audit report to produce documentation to address any\ndiscrepancies found during an audit;\n(12) The final audit report shall provide claim-level detail of the amounts and reasons for\neach claim recovery found due. If no amounts have been found due, the final audit\nreport shall so state;\n(13) The auditing entity shall not receive payment based on the amount recovered in an\naudit;\n(14) The auditing entity shall conduct an exit interview at the close of the audit. The exit\ninterview shall be conducted at a time agreed to by the audited pharmacy. The\ninterview shall provide the audited pharmacy an opportunity to:\n(a) Respond to questions from the auditing entity;\n(b) Review and comment on the initial findings of the auditing entity; and\n(c) Provide additional documentation to clarify the initial findings of the auditing\nentity;\n(15) If an audit results in the identification of any clerical or recordkeeping errors such as\ntypographical errors, scrivener's errors, omissions, or computer errors, the pharmacy\nshall not be subject to recoupment of funds by the auditing entity unless the auditing\nentity can provide proof of intent to commit fraud or the error results in an actual\noverpayment to the pharmacy or the wrong medication being dispensed to the\npatient. The pharmacy shall have the right to submit amended claims within thirty\n(30) days of the discovery of an error to correct clerical or rec ordkeeping errors in\nlieu of recoupment if the prescription was dispensed according to requirements set\nforth in state or federal law;\n(16) In the case of overpayment, the auditing entity may seek a refund or recoupment of\nthe overpayment in accordance wit h KRS 304.17A -712. The amount refunded or\nrecouped shall be limited to the amount paid to the pharmacy minus the amount that\nshould have been paid to the pharmacy absent the overpayment and shall not\ninclude the dispensing fee if the correct medication was  dispensed to the patient;\nand\n(17) Claims shall be paid pursuant to KRS 304.17A-702.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40126","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"11ee2ec3531f87abf38aa55b9b1b5e1bcc0f3b70bd5ec2fb26dfff1074c079c5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-740","next":"us-ky/krs-304.17a-743"},"notice":"GroundRules: Original legal text. Not legal advice."}