senate Bill S4218A
(D) 0 Senate District
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed/Vetoed by Governor
Limits the withholding of payment to a medical assistance program provider subject to a pending audit.
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
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.
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