S T A T E O F N E W Y O R K
________________________________________________________________________
9553
I N A S S E M B L Y
January 14, 2026
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Introduced by M. of A. PAULIN, REYES, ROSENTHAL, BURDICK, JACOBSON,
MAGNARELLI, REILLY, SCHIAVONI, SHIMSKY, STIRPE, JENSEN -- read once
and referred to the Committee on Health
AN ACT to amend the public health law, in relation to the audit and
review of medical assistance program funds by the Medicaid inspector
general
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 37
to read as follows:
§ 37. AUDIT AND REVIEW OF MEDICAL ASSISTANCE PROGRAM FUNDS. WHERE THE
INSPECTOR DETERMINES AN OVERPAYMENT OF FUNDS HAS OCCURRED DUE TO A
PROVIDER'S SUBMISSION OF SUPPORTING RECORDS IN A FORM, FORMAT, OR METHOD
OF TRANSMISSION THAT IS NOT IN ACCORDANCE WITH PROGRAM REQUIREMENTS IN
EFFECT AT THE TIME OF THE CLAIM, BUT, DUE TO INTERVENING CHANGES TO
PROGRAM REQUIREMENTS, INCLUDING CHANGES TO STATE AGENCY GUIDELINES,
REGULATIONS, OR OTHER GUIDANCE, IS IN ACCORDANCE WITH THE REQUIREMENTS
IN EFFECT AT THE TIME OF THE INSPECTOR'S REVIEW OR DETERMINATION OR ANY
ADMINISTRATIVE REVIEWS AND OTHER COURT PROCEEDINGS RELATED TO THE
INSPECTOR'S REVIEW OR DETERMINATION, THEN, IN THE ABSENCE OF FRAUD OR
EVIDENCE THE PROVIDER RECEIVED REIMBURSEMENT FOR ITEMS OR SERVICES THAT
WERE NOT PROVIDED TO THE BENEFICIARY, OR THE BENEFICIARY WAS NOT ELIGI-
BLE FOR THE ITEMS OR SERVICES, RECOUPMENT FOR SUCH CLAIM DISALLOWANCES
SHALL BE LIMITED TO THE REIMBURSEMENT AMOUNT OF THE CLAIMS ACTUALLY
REVIEWED BY THE INSPECTOR WITHOUT EXTRAPOLATION, AND THE INSPECTOR SHALL
NOT INITIATE NEW OR ADDITIONAL REVIEWS AGAINST THE PROVIDER ON THE SAME
BASIS.
§ 2. This act shall take effect immediately and shall apply to audits
commenced on or after such effective date, audits pending as of such
date, and audits that the Medicaid inspector general has concluded but
which are under administrative review or other properly filed judicial
review or appeal.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14172-01-5