New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-1 - Medical Facilities › Section 86-1.4 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All fiscal and
					 statistical records and reports shall be subject to audit. All underlying
					 books, records and documentation which formed the basis for the fiscal and
					 statistical reports, filed by the medical facility with the department, shall
					 be kept and maintained by the facility for a period of time not less than six
					 years from the date of filing or the date upon which the fiscal and statistical
					 records were to be filed, whichever is the later date. In this respect, any
					 rate of payment certified or established by the State Commissioner of Health
					 prior to audit shall be construed to represent a provisional rate until such
					 audit is performed and completed, at which time such rate or adjusted rate will
					 be construed to represent the audited rate.
(b) Subsequent to the filing of fiscal and
					 statistical reports, field audits may be conducted of the records of medical
					 facilities in a time, manner and place to be determined by the State Department
					 of Health. Alternatively or in addition the department may, in its sole
					 discretion, conduct desk audits of such fiscal and statistical
					 reports.
(c) The required fiscal
					 and statistical reports shall be subject to audit for a period of six years
					 from the date of their filing with the department or from the date when due,
					 whichever is later. 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 commissioner from performing an audit pursuant to this
					 section.
(d) Upon completion of the
					 audit, the medical facility shall be afforded a closing conference. The medical
					 facility may appear in person or by any one authorized in writing to act on
					 behalf of the medical facility. The medical facility shall be afforded an
					 opportunity at such conference to produce additional documentation in support
					 of any modifications requested in the audit.
(e) The medical facility shall be provided
					 with the audit report and the rate computation sheet per audit. The audit
					 report shall be final unless within 30 days of receipt of the audit report, the
					 medical facility initiates a bureau review of such final audit report by
					 notifying the Division of Health Care Financing by registered or certified
					 mail, detailing the specific items of the audit report with which the provider
					 disagrees, and such other material as the provider wishes to submit in its
					 behalf, and forwarding all material documentation in support of the medical
					 facility's position.
(f) The
					 medical facility shall be notified in writing of the determination of the
					 controverted items of the final audit report, including a statement of the
					 reasons for such adjustments and the appropriate citation to applicable law,
					 regulation or policy. The audit findings as adjusted in accordance with the
					 determination of the bureau review shall be final, except that the medical
					 facility may, within 30 days of receipt of the determination of the bureau
					 review, initiate a hearing to refute those items of the audit report adverse to
					 the interests of the medical facility presenting a factual issue by serving on
					 the commissioner, by certified or registered mail, a notice containing a
					 statement of the legal authority and jurisdiction under which the hearing
					 should be held, a reference to the particular sections of the statutes and
					 rules involved and a statement of the controverted items of the audit report
					 and bureau determination, together with copies of any documentation relied on
					 by the medical facility in support of its position.
(1) Upon receipt of such notice the
					 commissioner shall:
(i) designate a hearing
					 officer to hear and recommend;
(ii)
					 establish a time and place for such hearing;
(iii) notify the medical facility of the time
					 and place of such hearing at least 15 days prior thereto; and
(iv) include in a notice of hearing those
					 issues of the audit report which are controverted in the notice served on the
					 commissioner by the medical facility.