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Federal and State Program Integrity in New York

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New York protects the integrity of federal and state programs by (1) requiring the department of social services to audit medical assistance payments;1 (2) prohibiting providers from referring a patient for services in which they have a financial relationship without first disclosing this relationship;2 (3) requiring certain service providers to report their ownership arrangements to the commissioner every two years;3 (4) authorizing the commissioner to investigate providers of services to the mentally disabled;4 and (5) requiring the department to develop the fraud detection and control capacity of the medical assistance information and payment system.5

 

Footnotes

  • 1. NY SOC SERV § 364.
  • 2. NY PUB HEALTH § 238-D.
  • 3. NY PUB HEALTH § 238-C.
  • 4. N.Y. Mental Hyg. Law § 31.07.
  • 5. NY SOC SERV § 367-b.

 

Federal and State Program Integrity in New York

Subtopic Statute/Regulation Description
Investigations/audits of insurance claims data compared to services provided Department Responsibility for Standards for Medical Assistance Payments to Providers and Quality Reporting of Providers – N.Y. Soc. Serv. Law § 364 Department Responsibility for Standards for Medical Assistance Payments to Providers and Quality Reporting of Providers This section falls under...
Functions, Duties and Responsibilities of the Inspector – N.Y. Pub. Health Law § 32 The Inspector’s functions, duties, and responsibilities include: Investigating complaints and medical assistance program fraud and abuse...
Requirements for Investigations and Inspections – N.Y. Mental Hyg. Law § 31.07 The commissioner may conduct investigations into the operations of providers of services to the mentally disabled and may inspect such providers...
Federal and State Program Integrity NY SOC SERV § 367-b Medical assistance information and payment system The department must create “a statewide medical assistance information and payments system...
Click on the individual state law in the table above to see our summary of the individual law.


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