N.Y. Comp. Codes R. & Regs. tit. 18 § 518.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 518.3 - Liability for overpayments

(a) The department may require repayment from the person submitting an incorrect or improper claim, or the person causing such claim to be submitted, or the person receiving payment for the claim.

(b) The department may require repayment for inappropriate, improper, unnecessary or excessive care, services or supplies from the person furnishing them, or the person under whose supervision they were furnished, or the person causing them to be furnished. In this respect, the department may recover the amount paid for such care, services or supplies from the person ordering or prescribing them even though payment was made to another person. Medical care, services or supplies ordered or prescribed will be considered excessive or not medically necessary unless the medical basis and specific need for them are fully and properly documented in the client's medical record.

(c) Persons furnishing, or supervising the furnishing of, medical care, services or supplies are jointly and severly liable for any overpayments resulting from the furnishing of the care, services or supplies. The amount of repayment which may be recovered from any person is the amount paid for furnishing the medical care, services or supplies, plus the amount paid to any other person as a result of his/her ordering or prescribing medical care, services or supplies, less any amount actually recovered from any other person which relates to the care, services or supplies for which repayment is sought.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 518.3