California Codes, Business and Professions Code - BPC, Division 2 — Healing Arts, Chapter 9.5 — Audits of Pharmacy Benefits, Section 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 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.
Notes
Exempts from the pharmacy-audit chapter an audit conducted because a pharmacy benefit manager, carrier, plan sponsor, or other third-party payer has indications supporting reasonable suspicion of criminal wrongdoing, willful misrepresentation, fraud, or abuse. The chapter also does not apply to audits conducted by or at the direction of the pharmacy board, specified state health departments, or Medicare.
Use as reference
Lexinter.net | California Code, Business and Professions Code - BPC § 4431 | https://laws.lexinter.net/codes/california/business-and-professions-code/division-2/chapter-9-5/section-4431