California · Business and Professions Code - BPC

BPC §4431: (a) Nothing in this chapter shall apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other third-party payer has indications that support a reason

Civil

What this law says, in plain English

This statute exempts certain audits from regulatory requirements when there is reasonable suspicion of criminal wrongdoing, fraud, or abuse, or when conducted by specified state health agencies or Medicare.

Read the full statutory text

(a) Nothing in this chapter shall apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other third-party payer has indications that support a reasonable suspicion that criminal wrongdoing, willful misrepresentation, fraud, or abuse has occurred. (b) Nothing in this chapter shall apply to an audit conducted by, or at the direction of, the California State Board of Pharmacy, the State Department of Health Care Services, the State Department of Public Health, or the Medicare program.

Verify at the official source: California legislative text

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