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New York Codes, Rules and Regulations (NYCRR)

Title 9 Part 9660

Executive Department

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2 sections

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Source version current through May 15, 2022

All 2 displayed sections in this Part carry the same compiled date. Status and warnings stay on each section.

9 NYCRR 9660.1 - Referral of suspected fraud and abuse

Later State Register activity may affect this section.

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Dates and status
NYCRR title agency
Executive Department
Section status
Section source receipt
Source version current through
May 15, 2022

Whenever, in the conduct of a review and verification into the eligibility of an applicant or the recertification of a participant, the evaluation of utilization review reports or participant profiles, there is evidence of program fraud or abuse by an applicant or participant, the contractor shall promptly refer the matter to the executive director for review.

9 NYCRR 9660.2 - Fraud and abuse

Later State Register activity may affect this section.

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Dates and status
NYCRR title agency
Executive Department
Section status
Section source receipt
Source version current through
May 15, 2022
(a)The executive director shall maintain a statewide program for investigation and referral for prosecution of violations of State laws pertaining to fraud or abuse in the program.
(b)Where initial review of a contractor referral indicates substantial potential for criminal prosecution, the executive director shall refer the matter to the Attorney General or local prosecutive authority. Where initial review does not indicate substantial potential for criminal prosecution, the executive director shall conduct further review to determine whether or not a participant's participation in the program should be restricted or terminated.
(c)Where review indicates substantial evidence of abusive practices, the participant may be removed from the program or restricted to a single provider.

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