Limits the withholding of payment to a medical assistance program provider subject to a pending audit.
BILL NUMBER: S4218A
TITLE OF BILL : An act to amend the public health law, in relation to limiting the withholding of payment to a medical assistance program provider subject to a pending audit
PURPOSE OF THE BILL : This bill provides limitations on the withholding of Medicaid payments based on preliminary findings of a pending audit.
SUMMARY OF SPECIFIC PROVISIONS : Section 1 amends Article 1, Title III of the Public Health Law by adding a new § 32-A related to auditing standards and procedures of the Office of the Medicaid Inspector General. The new §32-a prohibits withholding of Medicaid provider payments pursuant to preliminary findings of a pending audit unless the OMIG has made a written finding, based on probable cause, that the provider committed fraud or other criminal conduct involving the claims subject to the audit.
Section 2 sets forth the effective date.
JUSTIFICATION : In recent months, Medicaid providers have been the subject of intense audits by the office of the Medicaid Inspector General (OMIG) and contingency-based auditing firms at the state and county levels for administrative or clerical errors which, through the use of extrapolation, have resulted in exorbitant fines and payment recoupments per individual audit.
While the OMIG's efforts to identify and punish real Medicaid provider fraud and abuse are very important, some providers are being targeted by the OMIG for clerical mistakes, errors or misinterpretations that in no way constitute fraud and abuse.
The bill places limitations on the withholding of provider payments based on the preliminary findings of a pending audit unless there is a written finding, based on probable cause of fraud or criminal conduct.
PRIOR LEGISLATIVE HISTORY : 2007-2008: A.10333.
FISCAL IMPLICATIONS : None.
EFFECTIVE DATE : Immediately, application to withholding of payment in effect on or commencing after the effective date.
STATE OF NEW YORK ________________________________________________________________________ 4218--A 2009-2010 Regular Sessions IN SENATE April 17, 2009 ___________Introduced by Sen. STACHOWSKI -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to limiting the with- holding of payment to a medical assistance program provider subject to a pending audit THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 32-a to read as follows: S 32-A. WITHHOLDING OF PROVIDER PAYMENT PURSUANT TO PENDING AUDIT. WHERE A PROVIDER IS THE SUBJECT OF A PENDING AUDIT BY THE OFFICE, UNDER THIS TITLE OR SECTION THREE HUNDRED SIXTY-EIGHT-C OF THE SOCIAL SERVICES LAW, THE DEPARTMENT SHALL NOT WITHHOLD PAYMENT UNDER THE MEDICAL ASSIST- ANCE PROGRAM TO THE PROVIDER ON THE BASIS OF A PRELIMINARY FINDING OF THE PENDING AUDIT, UNLESS THE INSPECTOR HAS MADE A WRITTEN FINDING, BASED UPON PROBABLE CAUSE, THAT THE PROVIDER HAS COMMITTED FRAUD OR OTHER CRIMINAL CONDUCT INVOLVING THE CLAIMS SUBJECT TO THE AUDIT. PRIOR TO THE WITHHOLDING OF PAYMENT, THE OFFICE SHALL PROVIDE THE FINDING TO THE COMMISSIONER AND THE PROVIDER, AND A WRITTEN STATEMENT OF THE BASIS FOR THE FINDING TO THE COMMISSIONER. S 2. This act shall take effect immediately, and shall apply to any withholding of payment in effect on or commencing after the effective date of this act.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02131-06-9