HCRA Compliance Reviews
Notice to Electing Payors and Providers Defining the Term "Good Cause" for Failure to Produce Documentation During a HCRA Compliance Audit
Pursuant to New York State Public Health Law section 2807-j (5)(d), electing payors or designated providers which, in the course of a Department pool payment audit commenced on or after January 1, 2000, fail to produce data or documentation requested in furtherance of such audit within thirty days of such request, may be assessed a civil penalty by the Commissioner of up to ten thousand dollars for each such failure. Such civil penalty shall not be imposed if the payor or provider demonstrates good cause for the failure to timely produce such data or documentation.
Please be advised that it is the position and interpretation of the Department that "good cause" encompasses only those events or situations beyond the ability of the payor or provider to foresee or control. Ignorance of statutory requirements or a failure to anticipate the need to be able to retain and retrieve required data will not be accepted as "good cause".
Your ongoing assistance and cooperation in conducting such reviews is greatly appreciated.