Hugh T. Farley

June 21, 2011

State Senator Hugh T. Farley (R, C, I - Schenectady) announced that he and his colleagues in the State Senate approved legislation (S.3184) on June 20th to ensure appropriate due process protections for providers and recipients of Medicaid who come under the scrutiny of the Office of the Medicaid Inspector General (OMIG).

The legislation adds to the law which created the OMIG in 2007, to assure fairness and procedural clarity when audits are conducted.

Among the bill’s provisions, it would: allow for recovery of payments only after notice, and not less than 60 days after final agency action; prohibit the OMIG from re-auditing something audited by another agency unless for good cause; and, protect providers from penalty if they complied with agency policies or interpretations, which may not be changed retroactively.

Where a recovery is claimed for a technical or administrative error, the provider would have a chance to correct the defect and resubmit the claim within 60 days of being notified. The legislation also would require the OMIG give the provider a detailed written explanation of the extrapolation method used when calculating a Medicaid overpayment.

The legislation also establishes a Medicaid recipient due process, including notice of rights, including right to counsel and a fair hearing and a notice of findings before any recovery can be made.

The act would take effect October 1, 2011. It was delivered to the Assembly where it is sponsored by Assemblyman Richard Gottfried.