N.Y. Comp. Codes R. & Regs. tit. 9 § 9850.3

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

Section 9850.3 - Audit and record retention

(a) All fiscal and statistical records and reports of providers and prescriptions filled or refilled which are used for the purpose of establishing the provider's right to payment under the program, and any underlying books, logs, records and documentation which formed the basis for such fiscal and statistical records and reports, shall be subject to audit. Providers must maintain a contemporaneous signature log which shall contain at a minimum the following elements of information for all prescriptions, except those prescriptions which are delivered to the participant by courier or mail: the prescription number, the date the prescription was dispensed and the signature of the participant or the participant's authorized representative. All underlying books, logs, records and documentation, including all prescriptions filled or refilled, shall be kept and maintained by the provider for a period of not less than three years from the date of completion of such reports or the date upon which the fiscal and statistical records were required to be filed, whichever is later, or the date the prescription was filled or refilled. Failure to maintain accurate records in accordance with this section may result in the disallowance of any claims for which such documentation is lacking.

(b) All claims made under the program shall be subject to audit by the executive director or contractor for a period of three years from the date of their filing. 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 contractor from performing an audit pursuant to this Part.

(c) Notification to the provider of the intent to audit shall toll the period for record retention and audit. The audit shall commence within 60 days of the notification. However, this period may be extended for 60 days upon written notice to the provider. There shall be no more than one extension of a notification of intent to audit.

(d) If an audit has not been commenced within 60 days of a notification of intent to audit or within 120 days of an extended notification, the effectiveness of the notification shall lapse. However, subsequent notifications of intent to audit may be issued within the period described in subdivision (b) of this section. The passage of this period shall preclude the conduct of an audit unless there is in existence an unexpired notification of intent to audit or an extended notification. The passage of this period shall not prohibit the conclusion of an audit already begun.

(e) Notwithstanding the provisions of subdivisions (c) and (d) of this section, the period within which to commence an audit may be indefinitely extended on account of delays in the commencement of the audit caused or requested by the provider or a representative of the provider.

(f) The audit shall begin with an entrance conference at which the nature and extent of the audit shall be discussed. The time, manner and place of an audit shall be determined by the executive director or the contractor.

(g) In their discretion, the executive director or the contractor may terminate an audit at any time in the audit process. The provider shall be notified in writing of such termination. This written notification shall serve in the place of a closing conference, draft audit report or final audit report, as appropriate. If an audit is terminated, the executive director or the contractor is precluded from recommencing an audit of those items which were the subject of the terminated audit.

N.Y. Comp. Codes R. & Regs. Tit. 9 § 9850.3