BILL NUMBER: S9166

SPONSOR: RAMOS
 
TITLE OF BILL:

An act to amend the public health law, in relation to the recovery of
improperly expended medical assistance program funds

 
PURPOSE OR GENERAL IDEA OF BILL:

When an overpayment to a provider of services detected by an audit
conducted by OMIG is due to a clerical, technological or inadvertent
human error, such provider shall be afforded an opportunity to provide
evidence that the service identified in the claim was actually rendered
to nullify any reclamation by OMIG and limit any and all recoupment of
clerical, technological or inadvertent human errors at the sum actually
received by a provider.

 
SUMMARY OF PROVISIONS:

Amends provisions in the Public Health Law empowering the OMIG to imple-
ment rules and regulations to detect investigate and prevent fraud and
              

abuse in the Medicare program by limiting recoupment of funds dispensed
to a provider in which the services billed by that provider were actual-
ly rendered or received.

 
JUSTIFICATION:

The current audit practices of OMIG are patently unfair to participating
providers who serve Medicare patients. Current rules make no distinction
in reimbursement consequences when an audit detects actual and inten-
tional wrongdoing by a provider via fraud or abuse and inadvertent
errors in the record keeping and/or reporting of a provider who has
actually delivered the services to such recipient. In order to deter
intentional misconduct by providers, OMIG can, when an error rate is
detected in sample by an audit, retroactively extrapolate such error
rate onto a much larger pool of cases that such provider rendered in
previous years.

This bill will:

1. Prohibit recoupment in instances when the impropriety of such a
payment was due to clerical, technological or inadvertent human error,
but the provider can produce evidence that the service was actually
rendered to the Medicaid patient.

2. Limit recoupment to actual funds received for clerical, technological
or inadvertent human error.

 
PRIOR LEGISLATIVE HISTORY:

This is a new bill

 
FISCAL IMPACT:

To be determined

 
EFFECTIVE DATE:
This act shall take effect immediately