§ 4-05 Conduct of Hearings; Rights of Hospital.
RCNY § 4-05
(a)The judge shall preside over the hearing, make all procedural rulings, and make a statement on the record describing the nature of the proceedings, the issues, and the manner in which the hearing will be conducted.
(b)The issues and documentation presented at the hearing shall be limited to issues relating to determinations made in the final audit report. A hospital may not raise issues regarding the: (1) statistical sampling and extrapolation methodologies used to determine the disallowances; (2) disallowances where patient account records to substantiate billings were missing at the time of the audit; or (3) any issue that could have been raised, but was not, in a written response to the draft report.
(c)The rules of evidence observed by a court of law need not apply.
(d)Computer-generated documents prepared by the New York State Department of Social Services (NYSDSS) or its fiscal agent to show the nature and amount of payments made under the Medicaid program shall be presumed, in the absence of evidence to the contrary, to constitute an accurate reflection of NYSDSS' records as to the amount and type of payment made to a hospital as well as the basis for such payment.
(e)An extrapolation based upon a Comptroller's Office audit utilizing a valid statistical sampling method shall be presumed, in the absence of evidence to the contrary, to be accurate.
(f)An audit report of the Comptroller's Office shall be presumed to be correct and the burden of proof shall be upon the hospital to show by a preponderance of the evidence that any item of such report is incorrect.
(g)All testimony shall be given under oath or affirmation administered by the judge.
(h)The hospital shall be entitled to be represented, to have witnesses give testimony and to otherwise present relevant and material evidence on the hospital's behalf, to cross-examine witnesses and to examine any document or other item offered into evidence.
(i)A typed or recorded copy of the record of the hearing will be prepared by OATH; a copy shall be provided upon request for a reasonable cost.
(j)At the discretion of the judge, the hearing may be adjourned for good cause upon the request of either party or upon the judge's own motion.
(k)The hearing shall be conducted in conformity with procedural requirements of applicable law and the rules of procedure adopted by OATH which are not inconsistent with these rules.
(l)After the conclusion of the hearing, the presiding Administrative Law Judge will prepare a report and recommendation.
(m)The report will summarize the evidence presented and contain an analysis of the legal and factual issues, with recommended findings of fact and recommended dis- position.
(n)The report will be sent to the Comptroller for a final decision.
(o)A copy of the report will also be delivered or mailed to the hospital. (Renumbered City Record 6/29/2018, eff. 7/29/2018)
