Florida Pharmacies are Not Taking Advantage of Florida’s Prompt Pay Law
Frier Levitt recently Recouped $140,000 from a PBM After We Alleged Violations of Florida’s Prompt Pay Law. Know Your Rights, and Assert Them!
Frier Levitt is a boutique healthcare law firm dedicated to community pharmacies and curbing audit abuse. Frier Levitt recently learned of an unfair audit practice by various Pharmacy Benefits Managers (PBMs) whereby the PBMs ignore Florida law protecting Florida pharmacies.
Has a PBM wrongfully retracted new reimbursements because of alleged past overpayments, without a proper appeals process? We are looking for pharmacies that are tired of PBMs disregarding the law and that are willing to stand up to the PBMs. Unchecked PBM behavior erodes independent pharmacy profits. Frier Levitt’s business is fighting PBMs.
The Wrongful Conduct
PBMs routinely retract alleged past overpayments from pharmacies by reducing reimbursements of new claims. PBMs may have pervasively engaged in a practice of recouping such funds without providing sufficient time for the pharmacy to appeal the determination that the funds were overpaid and often over the pharmacy’s objections. This practice may violate Florida law. If you know your rights, you may have the upper hand.
Florida Prompt Pay Law Has Some Teeth
Florida has a Prompt Pay Law providing that all claims must be paid or denied by the PBM within 90 days after receipt of the claim. If a PBM determines that it has overpaid a Pharmacy, the PBM must make a claim for such overpayment to the Pharmacy’s designated location, with a statement specifying the basis for the retroactive denial or payment adjustment. The PBM must specifically identify the claim(s) or overpayment(s), for which a claim for overpayment is submitted. A Pharmacy must then pay, deny, or contest the PBM’s claim for overpayment within 35 days after the receipt of notice of overpayment from the PBM.
Most importantly, (and this is the part we love) the PBM may not reduce payment to the Pharmacy for other services unless the Pharmacy agrees to the reduction in writing or fails to respond to the PBM’s overpayment claim within 35 days. A PBM in Florida cannot retract alleged overpayments from future reimbursements without your consent!
The important take-away from this law is that if a PBM attempts to recoup alleged overpayments made to your pharmacy, you must send an appeal letter to the PBM within 35 days of your receipt of notification of “overpayment” from the PBM. Frier Levitt has routinely drafted these letters on behalf of its pharmacy clients and can provide these letters when your pharmacy receives notice of overpayment.
Despite this clear Florida Law, many PBMs pervasively violate this mandate by retracting payments made to pharmacies without providing the proper notification or time period. Frier Levitt recouped $140,000 from one PBM after catching the PBM’s improper conduct under Florida Law!
If any PBM has retracted alleged overpayments from future reimbursements to your pharmacy, Frier Levitt can help. If you have had similar experiences in Florida, or in any other state, contact Frier Levitt today.