California Legislature—2015–16 Regular Session

Assembly BillNo. 627


Introduced by Assembly Member Gomez

February 24, 2015


An act to amend Section 4431 of the Business and Professions Code, relating to audits of pharmacy benefits.

LEGISLATIVE COUNSEL’S DIGEST

AB 627, as introduced, Gomez. Audits of pharmacy benefits.

Existing law imposes specified requirements on an audit of pharmacy services provided to beneficiaries of a health benefit plan. Existing law provides that those requirements do not apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other 3rd-party payer has indications that support a reasonable suspicion that criminal wrongdoing, willful misrepresentation, fraud, or abuse has occurred, or 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.

This bill would make nonsubstantive changes to that provision.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

P1    1

SECTION 1.  

Section 4431 of the Business and Professions
2Code
is amended to read:

3

4431.  

(a) begin deleteNothing in this end deletebegin insertThis end insertchapter shallbegin insert notend insert apply to an
4audit conducted because a pharmacy benefit manager, carrier,
P2    1health benefit plan sponsor, or other third-party payer has
2indications that support a reasonable suspicion that criminal
3wrongdoing, willful misrepresentation, fraud, or abuse has
4occurred.

5(b) begin deleteNothing in this end deletebegin insertThis end insertchapter shallbegin insert notend insert apply to an audit
6conducted by, or at the direction of, the California State Board of
7Pharmacy, the State Department of Health Care Services, the State
8Department of Public Health, or the Medicare program.



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