New York Codes, Rules and Regulations › Title 14 - DEPARTMENT OF MENTAL HYGIENE › Chapter XIV - Office for People With Developmental Disabilities › Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities › Subpart 635-4 - Financial Reporting and Audit Requirements › Section 635-4.6 - Audits

Current through Register Vol. 46, No. 28, July 10, 2024
(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.