Post-Payment Audit Guidance
RIGHT TO INFORMATION
After a provider receives payment for the New York Medicaid EHR Incentive program, there is the possibility of a post-payment audit. All providers participating in the EHR incentive program are required to maintain all supporting documents, including any EHR screen shots, for a minimum of six years.
Post–payment audits will be conducted by the New York State Office of the Medicaid Inspector General (OMIG). OMIG will begin each audit with an Audit Notification Letter sent to the provider requesting the submission of documentation to support their signed attestation.
The following citations provide authority for OMIG´s review of records:
- SOCIAL SECURITY ACT § 1902(a) (42 U.S.C. § 1396a)
- "A State plan for medical assistance must...(27) provide for agreements with every person or institution providing services under the State plan under which such person or institution agrees (A) to keep such records as are necessary fully to disclose the extent of the services provided to individuals receiving assistance under the State plan, and (B) to furnish the State agency...with such information, regarding any payments claimed by such person or institution for providing services under the State plan, as the State agency...may from time to time request." 18 NYCRR Part 517
Pursuant to 18 NYCRR Part 517, the OMIG may conduct fiscal audits and reviews of a provider´s claims, books, records, reports, or other available documentation.
- "A State plan for medical assistance must...(27) provide for agreements with every person or institution providing services under the State plan under which such person or institution agrees (A) to keep such records as are necessary fully to disclose the extent of the services provided to individuals receiving assistance under the State plan, and (B) to furnish the State agency...with such information, regarding any payments claimed by such person or institution for providing services under the State plan, as the State agency...may from time to time request." 18 NYCRR Part 517
- 18 NYCRR § 504.3
- Pursuant to 18 NYCRR § 504.3 Duties of the provider, "By enrolling the provider agrees: (a) to prepare and to maintain contemporaneous records demonstrating its right to receive payment under the medical assistance program and to keep for a period of six years from the date the care, services or supplies were furnished, all records necessary to disclose the nature and extent of services furnished and all information regarding claims for payment submitted by, or on behalf of, the provider and to furnish such records and information, upon request, to the department, the Secretary of the United States Department of Health and Human Services, the Deputy Attorney General for Medicaid Fraud Control and the New York State Department of Health;" and "(g) to permit audits, by the persons and agencies denominated in subdivision (a) of this section, of all books and records or, in the discretion of the auditing agency, a sample thereof, relating to services furnished and payments received under the medical assistance program, including patient histories, case files and patient–specific data."
- PUBLIC HEALTH LAW § 32(9)
- The OMIG shall have the power to require and compel the production of such books, papers, records and documents as may be deemed to be relevant or material to an investigation, examination or review.
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