Bill > A01069

This bill requires the Medicaid Inspector General to follow specific standards when auditing and reviewing medical assistance program funds, establishing a more transparent and fair process for healthcare providers. The bill defines key terms like "overpayment" (any unauthorized payment due to errors, fraud, or mistakes) and "clerical or minor error" (including things like mathematical mistakes or incorrect data entry). When conducting audits, the inspector must now provide providers with applicable standards beforehand, publish audit protocols on their website, and consider factors like the severity of errors, potential impact on provider financial solvency, and potential disruption to patient service access. The bill mandates that if minor errors are isolated (three or fewer occurrences), extrapolation cannot be used, and recoupment will be limited to specific affected claims. Additionally, the inspector must provide detailed draft audit reports explaining sampling methodologies, allow providers to submit supporting documentation, and provide written explanations for rejecting such documentation. The bill also requires the inspector to include a narrative in their annual report describing how they balance enforcement actions with maintaining quality and availability of medical services. These provisions aim to create a more balanced and transparent audit process for Medicaid providers, protecting both the state's interests and healthcare providers' ability to serve patients.

Budget and Finance, Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A1069