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DSS Releases Proposed Provider Audit Regulations

October 23, 2012

On October 16, 2012, the Connecticut Department of Social Services (“DSS”) published proposed regulations addressing the auditing of providers (the “Providers”) who receive Medicaid reimbursement (the “Proposed Regulations”).  A copy of the Proposed Regulations can be read here.

  1. Section 17b-99 of the Connecticut General StatutesSection 17b-99 of the Connecticut General Statutes sets forth the general rules regarding how DSS must conduct Provider audits.  After years of complaints from Providers concerning the lack of specifics regarding the processes and procedures for DSS audits, DSS has drafted and issued notice of the Proposed Regulations which aim to give Providers the desired details surrounding such audits.
  2. Proposed RegulationsAs currently drafted, the Proposed Regulations will address, among other things:  (A) the manner in which DSS will use its sampling and extrapolation methodology; (B) a description of how the audit process will be conducted; (C) the processes and procedures for requesting and conducting reviews of final audit reports; and (D) how DSS will recover overpayments from Providers including DSS’s right to recoup overpayments from a Provider who is not subject to the audit, but who is owned or controlled by the same person or entity that owns or controls the Provider who is being audited. 
  3. Opportunity to Provide Comments and/or Request a HearingInterested parties may submit written comments, questions, and concerns regarding the Proposed Regulations to DSS by November 14, 2012 to the Department of Social Services, Office of Legal Counsel, Regulations & Administrative Hearings, 25 Sigourney Street, Hartford, CT 06106, Attention: Brenda Parrella, Director.  A hearing will be scheduled on the Proposed Regulations if requested by 15 or more persons or an association having 15 or more members if requested in writing by October 29, 2012.  If submitting comments or requesting a hearing, reference Regulation Control Number 11-13JM in your correspondence.

If you have any questions or would like additional information regarding the Proposed Regulations, please contact our Health Law Practice Group.


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