Sec. 17b-265f. Payment by the department for pharmacy claims. Limitations. Investigation of pharmacy.
Sec. 17b-265f. Payment by the department for pharmacy claims. Limitations.
Investigation of pharmacy. No pharmacy shall claim payment from the Department
of Social Services under a medical assistance program administered by the department
or the Medicare Part D Supplemental Needs Fund, established pursuant to section 17b-265e, for prescription drugs dispensed to individuals who have other prescription drug
insurance coverage unless such coverage has been exhausted and the individual is otherwise eligible for such a medical assistance program or assistance from the Medicare
Part D Supplemental Needs Fund. The department shall recoup from the submitting
pharmacy any claims submitted to and paid by the department when other insurance
coverage is available. The department shall investigate a pharmacy that consistently
submits ineligible claims for payment to determine whether the pharmacy is in violation
of its medical assistance provider agreement or is committing fraud or abuse in the
program and based on the findings of such investigation, may take action against such
pharmacy, in accordance with state and federal law.
(June Sp. Sess. P.A. 07-2, S. 21.)
History: June Sp. Sess. P.A. 07-2 effective June 26, 2007.