Bill > A09553

This bill aims to limit the amount of money that can be recovered by the Medicaid Inspector General when a healthcare provider is found to have submitted claims that didn't meet program requirements at the time, but now do due to updated guidelines or regulations. Specifically, if an overpayment occurred because the provider's records were submitted in a way that was not compliant with the rules then in place, but is now compliant because those rules have changed, the Inspector General can only recoup the actual amount paid for the specific claims that were reviewed, without using statistical methods to estimate other potential overpayments (this is known as "extrapolation"). Furthermore, the Inspector General cannot start new reviews against the provider for the same issue. This applies even if fraud or issues with service provision or beneficiary eligibility are not present, and the bill's provisions apply to audits that have already started, are ongoing, or are under administrative or judicial review.

Budget and Finance, Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A9553