An audit finding of an overpayment or underpayment of a claim:(1) must be based on an actual overpayment or underpayment; and(2) may not be based on a projection that is based on the number of:(A) patients who:(i) have similar diagnoses; and(ii) are served by the pharmacy; or(B) prescriptions for or refills of similar legend drugs that are dispensed by the pharmacy.As added by P.L.7-2009, SEC.1.
Indiana Legal Code