N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-4.6

Current through Register Vol. 46, No. 45, November 2, 2024

Section 635-4.6 - Audits

(a) All records, reports and data shall be subject to audit for the period of time specified in section 635-4.5(d) of this Subpart.

(b) The six year limitation shall not apply in situations in which fraud may be involved or where the provider or its agent prevents or obstructs a State or Federal agency from performing an audit pursuant to this section.

(c) All such records, reports and data shall be subject to audit by OPWDD, the Office of the State Comptroller, the State Department of Health, and by the agencies of the Federal government as provided by law.

(d) Field audits or desk audits shall be conducted by OPWDD or the Department of Health at a time and place and in a manner to be determined by OPWDD or the Department of Health.

(e) Federal and State agencies may perform the audits on any records required to be maintained.

(f) Any finding of an audit described in this section shall constitute grounds for recoupment at the discretion of OPWDD, provided that such audit findings relate to the allowable costs, and to the extent that the audit finding has been upheld in a decision after a hearing or a hearing has not been requested on such finding.

(g) Administrative review (including hearings) of audits conducted to determine allowable Medicaid expenses and offsetting revenues shall be in accordance with 18 NYCRR Part 517.

(h) Administrative review of audits which are conducted by OPWDD, and which are not described in subdivision (g) of this section, shall be in accordance with the following:

(1) At the conclusion of the audit, the provider shall be afforded an opportunity to submit additional documentation to OPWDD. After the receipt and review of such additional documentation, a copy of the audit findings shall, within 120 days, be sent to the provider by certified mail, return receipt requested. In order to have the additional documentation considered, the provider must submit the documentation within the time specified.

(2) The audit findings shall become final unless, within 30 days of receipt thereof, the provider requests an administrative review of the audit findings.

(3) The provider must send a request for administrative review of audit findings to OPWDD by certified mail, return receipt requested.

(4) Such requests shall contain a detailed statement of the provider's objections to the findings, along with copies of any documentation the provider wishes to submit.

(5) The provider shall be notified in writing of the determination on those items to which the provider objected, including a statement of the reasons for the determination. The audit findings, as adjusted in accordance with the determination after administrative review, shall be final.

N.Y. Comp. Codes R. & Regs. Tit. 14 §§ 635-4.6

Amended New York State Register October 28, 2015/Volume XXXVII, Issue 43, eff. 11/1/2015

Amended New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff. 4/20/2016

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016