NY State Senate Bill 2025-S5799

Senate Bill S5799

2025-2026 Legislative Session

Relates to audits conducted by the office of Medicaid inspector general detecting ministerial or clerical errors that generate an overpayment

download bill text pdf

Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 03, 2025	referred to health

2025-S5799 (ACTIVE) - Details

See Assembly Version of this Bill:: A3898
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §37, Pub Health L
Versions Introduced in 2023-2024 Legislative Session:: S8684, A7584

2025-S5799 (ACTIVE) - Summary

Relates to audits conducted by the office of Medicaid inspector general detecting ministerial or clerical errors that generate an overpayment to a vendor providing non-emergency medical transportation services.

2025-S5799 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5799

SPONSOR: SEPULVEDA
 
TITLE OF BILL:

An act to amend the public health law, in relation to audits conducted
by the office of Medicaid inspector general detecting ministerial or
clerical errors that generate an overpayment to certain services

 
PURPOSE:

When an overpayment to a provider of services detected by an audit
conducted by OMIG is due to a clerical, technological or inadvertent
human error, such provider shall be afforded an opportunity to provide
evidence that the service identified in the claim was actually rendered
to nullify any reclamation by OMIG.

 
SUMMARY OF PROVISIONS:

Amends provisions in the Public Health Law empowering the OMIG to imple-
ment rules and regulations to detect, investigate and prevent fraud and
abuse in the Medicaid program by limiting recoupment of funds dispensed

to a provider who has actually rendered non-emergency medical transpor-
tation services after an audit has detected ministerial or inadvertent
billing errors by such vendor.

 
JUSTIFICATION:

The current audit practices of OMIG are patently unfair to participating
providers who serve Medicaid patients. Current rules make no distinction
in reimbursement consequences when an audit detects actual and inten-
tional wrongdoing by a provider via fraud or abuse and inadvertent
errors in the record keeping and/or reporting of a provider who has
actually delivered the services to such recipient. In order to deter
intentional misconduct by providers, OMIG can, when an error rate is
detected in sample by an audit, retroactively extrapolate such error
rate onto a much larger pool of cases that such provider rendered in
previous years. This bill will prohibit recoupment when the impropriety
of such a payment was due to clerical, technological or inadvertent
human error, but the provider can produce evidence that the service was
rendered to the Medicaid patient.

 
LEGISLATIVE HISTORY:

S.8684 of 2023-2024: Referred to Health

 
FISCAL IMPLICATIONS:

TBD

 
EFFECTIVE DATE:
Immediately.

2025-S5799 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5799
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               March 3, 2025
                                ___________
 
 Introduced by Sen. SEPULVEDA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN  ACT  to amend the public health law, in relation to audits conducted
   by the office of Medicaid inspector general detecting  ministerial  or
   clerical errors that generate an overpayment to certain services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding a new section 37
 to read as follows:
   § 37. OVERPAYMENT; PROCEDURES,  PRACTICES  AND  STANDARDS  IN  CERTAIN
 INSTANCES. 1. SUBJECT TO FEDERAL LAW OR REGULATION, RECOVERY OF AN OVER-
 PAYMENT  RESULTING  FROM  THE  ISSUANCE OF A FINAL AUDIT REPORT OR FINAL
 NOTICE OF AGENCY ACTION BY THE INSPECTOR SHALL COMMENCE  NOT  LESS  THAN
 SIXTY  DAYS AFTER THE ISSUANCE OF THE FINAL AUDIT REPORT OR FINAL NOTICE
 OF AGENCY ACTION REGARDING THE DELIVERY OF NON-EMERGENCY MEDICAL  TRANS-
 PORTATION  SERVICES  TO  RECIPIENTS  ENROLLED  IN THE MEDICAL ASSISTANCE
 PROGRAM.
   2. ANY VENDOR PROVIDING NON-EMERGENCY MEDICAL TRANSPORTATION  SERVICES
 WHO  HAS BEEN COMPENSATED FOR SUCH SERVICE, AND AFTER AN AUDIT CONDUCTED
 BY THE INSPECTOR, HAD SUCH COMPENSATION DISQUALIFIED AND DENOMINATED  AN
 OVERPAYMENT DUE TO A MINISTERIAL OR INADVERTENT ERROR IN RECORD KEEPING,
 MAY  BE  AFFORDED  A  REASONABLE  TIME TO PROVIDE AND SUBMIT INDEPENDENT
 PROOF THAT SUCH SERVICE WAS ACTUALLY RENDERED TO A RECIPIENT ENROLLED IN
 THE MEDICAL ASSISTANCE PROGRAM. IN SUCH INSTANCES,  SUBJECT  TO  FEDERAL
 LAW  OR  REGULATION,  THE INSPECTOR SHALL AMEND THE FINAL AUDIT OR FINAL
 NOTICE OF AGENCY ACTION TO ELIMINATE  AND  REDUCE  THE  OVERPAYMENT  SUM
 STATED  THEREIN,  INCLUDING  ANY EXTRAPOLATION CALCULATION DERIVATIVE OF
 SUCH ALLEGED OVERPAYMENT, FOR EACH INSTANCE THAT THE VENDOR  CAN  ESTAB-
 LISH  BY  INDEPENDENT  PROOF  THAT TRANSPORTATION SERVICES WERE ACTUALLY
 RENDERED TO A RECIPIENT ENROLLED IN THE MEDICAL ASSISTANCE PROGRAM.
   § 2. This act shall take effect immediately.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD01430-01-5

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