New York Codes, Rules and Regulations › Title 9 - EXECUTIVE DEPARTMENT › Subtitle KK - Program for Elderly Pharmaceutical Insurance Coverage › Part 9850 - Audits And Recovery Of Overpayments › Section 9850.3 - Audit and record retention

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				All fiscal and statistical records and reports of providers and prescriptions
				filled or refilled which are used for the purpose of establishing the
				provider's right to payment under the program, and any underlying books, logs,
				records and documentation which formed the basis for such fiscal and
				statistical records and reports, shall be subject to audit. Providers must
				maintain a contemporaneous signature log which shall contain at a minimum the
				following elements of information for all prescriptions, except those
				prescriptions which are delivered to the participant by courier or mail: the
				prescription number, the date the prescription was dispensed and the signature
				of the participant or the participant's authorized representative. All
				underlying books, logs, records and documentation, including all prescriptions
				filled or refilled, shall be kept and maintained by the provider for a period
				of not less than three years from the date of completion of such reports or the
				date upon which the fiscal and statistical records were required to be filed,
				whichever is later, or the date the prescription was filled or refilled.
				Failure to maintain accurate records in accordance with this section may result
				in the disallowance of any claims for which such documentation is
				lacking.
(b) All claims made under
				the program shall be subject to audit by the executive director or contractor
				for a period of three years from the date of their filing. This limitation
				shall not apply to situations in which fraud may be involved or where the
				provider or an agent thereof prevents or obstructs the contractor from
				performing an audit pursuant to this Part.
(c) Notification to the provider of the
				intent to audit shall toll the period for record retention and audit. The audit
				shall commence within 60 days of the notification. However, this period may be
				extended for 60 days upon written notice to the provider. There shall be no
				more than one extension of a notification of intent to audit.
(d) If an audit has not been commenced within
				60 days of a notification of intent to audit or within 120 days of an extended
				notification, the effectiveness of the notification shall lapse. However,
				subsequent notifications of intent to audit may be issued within the period
				described in subdivision (b) of this section. The passage of this period shall
				preclude the conduct of an audit unless there is in existence an unexpired
				notification of intent to audit or an extended notification. The passage of
				this period shall not prohibit the conclusion of an audit already
				begun.
(e) Notwithstanding the
				provisions of subdivisions (c) and (d) of this section, the period within which
				to commence an audit may be indefinitely extended on account of delays in the
				commencement of the audit caused or requested by the provider or a
				representative of the provider.
(f)
				The audit shall begin with an entrance conference at which the nature and
				extent of the audit shall be discussed. The time, manner and place of an audit
				shall be determined by the executive director or the contractor.
(g) In their discretion, the executive
				director or the contractor may terminate an audit at any time in the audit
				process. The provider shall be notified in writing of such termination. This
				written notification shall serve in the place of a closing conference, draft
				audit report or final audit report, as appropriate. If an audit is terminated,
				the executive director or the contractor is precluded from recommencing an
				audit of those items which were the subject of the terminated audit.