LeadingAge New York Pursues PRI Audit Case

LeadingAge New York is asking the state’s highest court – the Court of Appeals – to hear a case challenging the Office of the Medicaid Inspector General’s (OMIG) authority to audit nursing home patient review instruments (PRIs). The outcome of the case could also affect OMIG’s plans to audit PRIs for assisted living programs and nursing home MDS assessments.

In a Nov. 1, 2012 decision, the Appellate Division of the NYS Supreme Court upheld a 2011 Albany County Supreme Court determination in NYSHFA v. Sheehan that OMIG has the authority to audit PRIs. LeadingAge NY has petitioned the Court of Appeals to intervene in the case as an amicus curiae (“friend of the court”). Our brief argues that OMIG has failed to follow the DOH PRI audit protocols on properly staging audits; considering various forms of documentation and timely observing affected residents. In upholding OMIG’s authority to audit PRIs, the lower courts have also noted that alleged procedural flaws in individual OMIG PRI audits can be challenged administratively and legally. Several LeadingAge NY member facilities are currently undergoing PRI audits, and the Association has met with OMIG to contest various findings.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866