An audit finding of an overpayment or underpayment of a claim:

1. (1) must be based on an actual overpayment or underpayment; and

2. (2) may not be based on a projection that is based on the number of:

   1. (A) patients who:

      1. (i) have similar diagnoses; and
      2. (ii) are served by the pharmacy; or
   2. (B) prescriptions for or refills of similar legend drugs that are dispensed by the pharmacy.

As added by P.L.7-2009, SEC.1.