ORS 735.552: Pharmacy claims audits; exception for fraud.
Edition: 2025 EditionEffective: 2026-01-01Last verified: 2026-09-07
ORS 735.540 to 735.552 do not: (1) Preclude an entity from instituting an action for fraud against a pharmacy; (2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by physical review, review of claims data or statements or other investigative methods; or (3) Apply to a state agency that is conducting audits or a person that has contracted with a state agency to conduct audits of pharmacy records for prescription drugs paid for by the state medical assistance program. [2013 c.570 §10]
Official history and status
History: Note: See note under 735.530.
Administrative rules citing this section
- OAR 836-200-0401: Statement of Purpose; Authority; Applicability — implements
- OAR 836-200-0421: Service on Licensee — implements
- OAR 836-200-0436: Submission of Complaints — implements
This rule cites
- ORS 735.540 — resolved
- 735.552 — resolved
Cited by
- ORS 735.530: Definitions for ORS 735.530 to 735.552.
- ORS 735.532: License to transact business as pharmacy benefit manager; fees; rules.
- ORS 735.533: Denial, suspension or revocation of license to transact business as pharmacy benefit manager; basis; complaint; rules.
- ORS 735.534: Claim reimbursement; maximum allowable costs; documentation; complaints; rules.
- ORS 735.540: Definitions for ORS 735.540 to 735.552.
- ORS 735.548: Pharmacy claims audits; validation of claims.
- OAR 836-200-0401: Statement of Purpose; Authority; Applicability
- OAR 836-200-0436: Submission of Complaints
- OAR 836-200-0440: Market Conduct Requirements for Pharmacy Benefit Managers
Official source: https://www.oregonlegislature.gov/bills_laws/ors/ors735.html