reglab/housing_qa huggingface dataset:
AK Stat § 21.27.910 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.910. Pharmacy audit procedural requirements.

(a) When a pharmacy benefits manager conducts an audit of the records of a pharmacy, the period covered by the audit of a claim may not exceed two years from the date that the claim was submitted to or adjudicated by the pharmacy benefits manager, whichever is earlier. Except as required under AS 21.36.495, a claim submitted to or adjudicated by a pharmacy benefits manager does not accrue interest during the audit period.  (b) A pharmacy benefits manager conducting an on-site audit shall give the pharmacy written notice of at least 10 business days before conducting an initial audit. (c) A pharmacy benefits manager may not conduct (1) an audit during the first seven calendar days of any month unless agreed to by the pharmacy; (2) more than one on-site audit of a pharmacy within a 12-month period; or (3) on-site audits of more than 250 separate prescriptions at one pharmacy within a 12-month period unless fraud by the pharmacy or an employee of the pharmacy is alleged. (d) If an audit involves clinical or professional judgment, the individual conducting the audit must (1) be a pharmacist who is licensed and in good standing under AS 08.80; or  (2) conduct the audit in consultation with a pharmacist who is licensed and in good standing under AS 08.80.  (e) A pharmacy, in responding to an audit, may use (1) verifiable statements or records, including medication administration records of a nursing home, assisted living facility, hospital, physician, or other authorized practitioner, to validate the pharmacy record; (2) a legal prescription to validate claims in connection with prescriptions, refills, or changes in prescriptions, including medication administration records, prescriptions transmitted by facsimile, electronic prescriptions, or documented telephone calls from the prescriber or the prescriber's agent. (f) A pharmacy benefits manager shall audit each pharmacy under the same standards and parameters as other similarly situated pharmacies in a network pharmacy contract in this state.
AK Stat § 21.27.915 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.915. Overpayment or underpayment.

(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base a finding of overpayment or underpayment by the pharmacy on the actual overpayment or underpayment and not on a projection based on the number of patients served having a similar diagnosis or on the number of similar orders or refills for similar drugs, except as provided in (b) of this section. (b) A pharmacy benefits manager may resolve a finding of overpayment or underpayment by entering into a settlement agreement with the pharmacy. The settlement agreement (1) must comply with the requirements of AS 21.36.125; and (2) may be based on a statistically justifiable projection method. (c) A pharmacy benefits manager may not include the dispensing fee amount in a finding of an overpayment unless (1) a prescription was not actually dispensed; (2) the prescriber denied authorization; (3) the prescription dispensed was a medication error by the pharmacy; or (4) the identified overpayment is solely based on an extra dispensing fee.
AK Stat § 21.27.920 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.920. Recoupment.

(a) When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager shall base the recoupment of overpayments on the actual overpayment of the claim, except as provided in AS 21.27.915(b). (b) A pharmacy benefits manager conducting an audit of a pharmacy may not (1) use extrapolation in calculating recoupments or penalties for audits, unless required by state or federal contracts; (2) assess a charge-back, recoupment, or other penalty against a pharmacy solely because a prescription is mailed or delivered at the request of a patient; or (3) receive payment (A) based on a percentage of the amount recovered; or (B) for errors that have no actual financial harm to the patient or medical plan.
AK Stat § 21.27.925 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.925. Pharmacy audit reports.

(a) A pharmacy benefits manager shall deliver a preliminary audit report to the pharmacy audited within 60 days after the conclusion of the audit. (b) A pharmacy benefits manager shall allow the pharmacy at least 30 days following receipt of the preliminary audit report to provide documentation to the pharmacy benefits manager to address a discrepancy found in the audit. A pharmacy benefits manager may grant a reasonable extension upon request by the pharmacy. (c) A pharmacy benefits manager shall deliver a final audit report to the pharmacy within 120 days after receipt of the preliminary audit report, settlement agreement, or final appeal, whichever is latest.
AK Stat § 21.27.930 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.930. Pharmacy audit appeal; future repayment.

(a) A pharmacy benefits manager conducting an audit shall establish a written appeals process. (b) Recoupment of disputed funds or repayment of funds to the pharmacy benefits manager by the pharmacy, if permitted by contract, shall occur, to the extent demonstrated or documented in the pharmacy audit findings, after final internal disposition of the audit, including the appeals process. If the identified discrepancy for an individual audit exceeds $15,000, future payments to the pharmacy may be withheld pending finalization of the audit. (c) A pharmacy benefits manager may not assess against a pharmacy a charge- back, recoupment, or other penalty until the pharmacy benefits manager's appeals process has been exhausted and the final report or settlement agreement issued.
AK Stat § 21.27.935 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.935. Fraudulent activity.

When a pharmacy benefits manager conducts an audit of a pharmacy, the pharmacy benefits manager may not consider unintentional clerical or record-keeping errors, including typographical errors, writer's errors, or computer errors regarding a required document or record, to be fraudulent activity. In this section, “fraudulent activity” means an intentional act of theft, deception, misrepresentation, or concealment committed by the pharmacy.
AK Stat § 21.27.940 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.940. Pharmacy audits; restrictions.

The requirements of AS 21.27.901 - 21.27.955 do not apply to an audit (1) in which suspected fraudulent activity or other intentional or wilful misrepresentation is evidenced by a physical review, a review of claims data, a statement, or another investigative method; or (2) of claims paid for under the medical assistance program under AS 47.07.
AK Stat § 21.27.945 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.945. Drug pricing list; procedural requirements.

(a) A pharmacy benefits manager shall (1) make available to each network pharmacy at the beginning of the term of the network pharmacy's contract, and upon renewal of the contract, the methodology and sources used to determine the drug pricing list; (2) provide a telephone number at which a network pharmacy may contact an employee of a pharmacy benefits manager to discuss the pharmacy's appeal; (3) provide a process for a network pharmacy to have ready access to the list specific to that pharmacy; (4) review and update applicable list information at least once every seven business days to reflect modification of list pricing; (5) update list prices within one business day after a significant price update or modification provided by the pharmacy benefits manager's national drug database provider; and (6) ensure that dispensing fees are not included in the calculation of the list pricing. (b) When establishing a list, the pharmacy benefits manager shall use (1) the most up-to-date pricing data to calculate reimbursement to a network pharmacy for drugs subject to list prices; (2) multi-source generic drugs that are sold or marketed in the state during the list period.
AK Stat § 21.27.950 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.950. Multi-source generic drug appeal.

(a) A pharmacy benefits manager shall establish a process by which a network pharmacy, or a network pharmacy's contracting agent, may appeal the reimbursement for a multi-source generic drug. A pharmacy benefits manager shall resolve an appeal from a network pharmacy within 10 calendar days after the network pharmacy or the contracting agent submits the appeal. (b) A network pharmacy, or a network pharmacy's contracting agent, may appeal a reimbursement from a pharmacy benefits manager for a multi-source generic drug if the reimbursement for the drug is less than the amount that the network pharmacy can purchase from two or more of its contracted suppliers. (c) A pharmacy benefits manager may grant a network pharmacy's appeal if an equivalent multi-source generic drug is not available at a price at or below the pharmacy benefits manager's list price for purchase from national or regional wholesalers who operate in the state. If an appeal is granted, the pharmacy benefits manager shall adjust the reimbursement of the network pharmacy to equal the network pharmacy acquisition cost for each paid claim included in the appeal. (d) If the pharmacy benefits manager denies a network pharmacy's appeal, the pharmacy benefits manager shall provide the network pharmacy with the (1) reason for the denial; (2) national drug code of an equivalent multi-source generic drug that has been purchased by another network pharmacy located in the state at a price that is equal to or less than the pharmacy benefits manager's list price within seven days after the network pharmacy appeals the claim; and (3) name of a pharmaceutical wholesaler who operates in the state in which the drug may be acquired by the challenging network pharmacy. (e) A network pharmacy may request a hearing under AS 21.06.170 - 21.06.240 for an adverse decision from a pharmacy benefits manager within 30 calendar days after receiving the decision. The parties may present all relevant information to the director for the director's review. (f) The director shall enter an order that (1) grants the network pharmacy's appeal and directs the pharmacy benefits manager to make an adjustment to the disputed claim; (2) denies the network pharmacy's appeal; or (3) directs other actions considered fair and equitable.
AK Stat § 21.27.955 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 27. Producers, Agents, Administrators, Brokers, Adjusters, and Managers|Article 9. Pharmacy Benefits Managers.|Sec. 21.27.955. Definitions.

In AS 21.27.901 - 21.27.955,  (1) “audit” means an official examination and verification of accounts and records; (2) “claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device; (3) “extrapolation” means the practice of inferring a frequency or dollar amount of overpayments, underpayments, invalid claims, or other errors on any portion of claims submitted, based on the frequency or dollar amount of overpayments, underpayments, invalid claims, or other errors actually measured in a sample of claims; (4) “list” means the list of multi-source generic drugs for which a predetermined reimbursement amount has been established such as a maximum allowable cost or maximum allowable cost list or any other list of prices used by a pharmacy benefits manager; (5) “multi-source generic drug” means any covered outpatient prescription drug that the United States Food and Drug Administration has determined is pharmaceutically equivalent or bioequivalent to the originator or name brand drug and for which there are at least two drug products that are rated as therapeutically equivalent under the United States Food and Drug Administration's most recent publication of “Approved Drug Products with Therapeutic Equivalence Evaluations”; (6) “network pharmacy” means a pharmacy that provides covered health care services or supplies to an insured or a member under a contract with a network plan to act as a participating provider; (7) “pharmacy” has the meaning given in AS 08.80.480;  (8) “pharmacy acquisition cost” means the amount that a pharmaceutical wholesaler or distributor charges for a pharmaceutical product as listed on the pharmacy's invoice; (9) “pharmacy benefits manager” means a person that contracts with a pharmacy on behalf of an insurer to process claims or pay pharmacies for prescription drugs or medical devices and supplies or provide network management for pharmacies; (10) “recoupment” means the amount that a pharmacy must remit to a pharmacy benefits manager when the pharmacy benefits manager has determined that an overpayment to the pharmacy has occurred.
AK Stat § 21.36.010 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.010. Purpose.

The purpose of this chapter is to regulate an act or a trade practice in the business of insurance in accordance with the intent of Congress as expressed in 15 U.S.C. 1011 - 1015 (McCarran-Ferguson Act) by defining or providing for determination of all the practices in this state that constitute an unfair method of competition or an unfair or deceptive act or practice and by prohibiting them.
AK Stat § 21.36.020 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.020. Unfair methods, deceptive acts prohibited.

A person may not engage in an act or a trade practice in this state or relative to a subject resident, located, or to be performed in this state that is defined in this chapter as, or determined under this chapter to be, an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.
AK Stat § 21.36.025 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.025. Unfair marketing practices prohibited.

(a) A person may not violate the applicable provisions of AS 21.56.180. (b) A person may not sell a membership in an association or labor union for the purpose of qualifying an individual for group insurance. (c) A person that sells a membership in an association may not offer group insurance for purposes of selling membership in an association or labor union.
AK Stat § 21.36.030 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.030. Misrepresentation and false advertising of insurance policies.

(a) A person may not make, issue, circulate, broadcast, or have made, issued, circulated, or broadcast an estimate, circular, statement, illustration, comparison, assertion, or other written, electronic, or oral presentation that (1) misrepresents the benefits, advantages, conditions, sponsorship, source, or terms of an insurance policy or a health discount plan; (2) misrepresents the dividends or share of the surplus to be received on an insurance policy; (3) misrepresents an insurance policy as being a share or shares of stock; (4) makes a false or misleading statement as to the dividends or shares of the surplus previously paid on an insurance policy; (5) misrepresents or makes a misleading statement as to the financial condition of an insurer or as to the legal reserve system upon which a life insurer operates; (6) uses a name or title of an insurance policy or class of insurance policies misrepresenting its true nature; (7) is a misrepresentation for the purpose of inducing, or that tends to induce the lapse, forfeiture, exchange, conversion, or surrender of an insurance policy; (8) is a misrepresentation for the purpose of effecting or tending to effect a pledge or assignment of or loan against an insurance policy; (9) appears to be an actual policy for a named individual when it is merely an advertisement; (10) does not clearly designate the name of the insurer providing the coverage or about which the statements are made; (11) is in any other way misleading, false, or deceptive; (12) misrepresents a health discount plan as a form or type of insurance; (13) describes a health discount plan using common insurance terminology; or (14) misrepresents that a health discount plan is underwritten by or associated with an insurer. (b) In this section, “misrepresentation” includes any statement or omission of a statement that when taken in the context of the whole presentation may tend to mislead or deceive the person or persons addressed.
AK Stat § 21.36.040 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.040. False information, advertising.

A person may not make, publish, disseminate, circulate, or place before the public, or cause, directly or indirectly, to be made, published, disseminated, circulated, or placed before the public, in a newspaper, magazine, or other publication, or in the form of a notice, circular, pamphlet, letter, or poster, or over a radio or television station, or in any other way, an advertisement, announcement, or statement containing an assertion, representation, or statement with respect to the business of insurance or with respect to a person in the conduct of the person's insurance business, that is untrue, deceptive, or misleading.
AK Stat § 21.36.050 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.050. Twisting prohibited.

A person may not make or issue, or cause to be made or issued, a written or oral statement misrepresenting or making incomplete comparisons as to the terms, conditions, or benefits contained in a policy for the purpose of inducing or attempting or tending to induce the policyholder to lapse, forfeit, surrender, retain, exchange, or convert an insurance policy.
AK Stat § 21.36.060 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.060. False or misleading financial statements.

(a) A person may not knowingly file with a public official, or knowingly make, publish, disseminate, circulate, or deliver to a person, or place before the public, or knowingly cause, directly or indirectly, to be made, published, disseminated, circulated, delivered to a person, or placed before the public, a false statement of the financial condition of a person in the insurance business. (b) A person may not make a false entry in a book, report, or statement of a person in the insurance business, knowing it to be a false entry, or knowingly omit to make a true entry of a material fact pertaining to the business of a person in the insurance business in a book, report, or statement. (c) A person may not, directly or indirectly, in connection with an audit, review, or communication required under AS 21.09.200, (1) make or cause to be made a materially false or misleading statement to an accountant; or (2) omit to state or cause another person to omit to state any material fact necessary in order to make other statements made not misleading to an accountant. (d) A person may not, directly or indirectly, take any action to coerce, manipulate, mislead, or fraudulently influence any accountant engaged in the performance of an audit under AS 21.09.200 if that person knew or should have known that the action, if successful, could result in rendering the insurer's financial statement materially misleading.
AK Stat § 21.36.070 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.070. Defamation.

(a) A person may not make, publish, disseminate, or circulate, directly or indirectly, or aid, abet, or encourage the making, publishing, disseminating, or circulating of an oral or written statement or a pamphlet, circular, article, or literature that is false, or maliciously critical of or derogatory to the financial condition of a person in the insurance business or proposing to enter the insurance business and that is calculated to injure a person engaged or proposing to engage in the business of insurance. (b) A person providing the director with information concerning the financial condition or an act or a practice of a licensee of the division is immune from liability for defamation.
AK Stat § 21.36.080 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.080. Boycott, coercion, and intimidation.

A person may not enter into an agreement to commit, or by any concerted action commit, an act of boycott, coercion, or intimidation resulting in or tending to result in unreasonable restraint of, or monopoly in, the business of insurance.
AK Stat § 21.36.090 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 36. Trade Practices and Frauds|Article 1. Trade Practices in General.|Sec. 21.36.090. Unfair discrimination.

(a) A person may not make or permit unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for a contract of life insurance or of life annuity or in the dividends or other benefits payable thereon, or in any other of the terms and conditions of the contract. (b) A person may not make or permit unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium, policy fees, or rates charged for a policy or contract of health insurance or in the benefits payable, or in any of the terms or conditions of the contract, or in any other manner whatever. (c) A person may not make or permit arbitrary or unfair discrimination between insureds or property having like insuring or risk characteristics, in the premium or rates charged for a policy or contract of property, casualty, surety, marine, wet marine or transportation insurance, or in the dividends or other benefits payable on the insurance, or in the selection of it, or in any other of the terms and conditions of the insurance. (d) Except to the extent necessary to comply with AS 21.42.365 and AS 21.56, a person may not practice or permit unfair discrimination against a person who provides a service covered under a group health insurance policy that extends coverage on an expense incurred basis, or under a group service or indemnity type contract issued by a health maintenance organization or a nonprofit corporation, if the service is within the scope of the provider's occupational license. In this subsection, “provider” means a state licensed physician, physician assistant, dentist, osteopath, optometrist, chiropractor, advanced practice registered nurse, naturopath, physical therapist, occupational therapist, marital and family therapist, psychologist, psychological associate, licensed clinical social worker, licensed professional counselor, or certified direct-entry midwife.