New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 517 - Provider Audits
Section 517.5 - Draft audit report
Current through Register Vol. 46, No. 39, September 25, 2024
(a) If, after affording the provider the opportunity for a closing conference upon completion of an on-site field audit and after consideration of any additional documentation and information presented in connection therewith, or after a review of a provider's claims and payments on in-house post-payment review, the department believes that overpayments have been made to the provider, a draft audit report may be issued identifying the items which are being disallowed and advising the provider of the basis for the proposed action and the legal authority therefor. When feasible, the draft report will also specify the amount of the overpayment.
(b) The draft audit report must contain a clear statement of the action to be taken, must afford the provider the opportunity to object to the proposed action within 30 days of receipt of this notice, must advise the provider that failure to object within the time provided may result in the adoption of the proposed action as the final agency action and must advise the provider that, pursuant to section 519.18 of this Title, the issues to be addressed at an administrative hearing will be limited to those matters contained in any objection to the proposed action.
(c) The report must be mailed to the provider's designated payment address or correspondence address or last known address and must be accompanied by a document identifying the person to whom objections to the report should be mailed. The provider's objections to the draft audit report must be mailed by the provider to that person within 30 days of receipt of the report which will be presumed in the absence of evidence to the contrary to be five days after the date on the draft report. Any objection must include a statement detailing the specific items of the draft report to which the provider objects and provide any additional material or documentation which the provider wishes to be considered in support of the objections.
