175.997 Utilization and Audits:
MSSNY is working with the New York State Department of Social Services and the New York State Department of Health to establish protocols against inappropriate utilization of Medicaid services and commensurate expenditures and to address the needs for: (1) Clear utilization of services parameters for dissemination to the physician community to guide physicians in the provision of health care under the Medical Assistance Program; (2) Development of more palatable and equitable methodologies to ensure appropriateness in audit investigations through mutually agreeable physician peer review activities and any disputes arising from such a peer review process. (Council 12/19/92; Reaffirmed HOD 2014; Reaffirmed HOD 2024)
