Year-End Deadline for NY Medicaid Providers and Third-Party Billers

December 13, 2017 | Benjamin P. Malerba | Ada Kozicz | Health Services

New York State Medicaid providers who claim, order or receive at least $500,000 from the Medicaid Program in any consecutive 12-month period have until December 31 to certify that they have implemented a compliance program aimed at detecting and preventing Medicaid fraud, waste and abuse. This requirement also applies to third-party billing companies that bill or receive the threshold amount on behalf of New York Medicaid providers.

In addition, facilities licensed under Article 28 or Article 36 of the New York Public Health Law (which include hospitals, ambulatory surgery centers, diagnostic and treatment centers, and home care agencies) must certify that they have a compliance program regardless of the amount they bill, order or receive from Medicaid.

Providers and other entities required to have a compliance program must certify as to the effectiveness of their compliance program by the end of each calendar year.

The 2017 Certification Form is available on the Office of the Medicaid Inspector General (“OMIG”) website at https://omig.ny.gov/ssl-certification. The form must be completed and submitted online by December 31, 2017. The “Certifying Official” who submits the form on behalf of a provider/entity must be a member of senior management or the governing board, and must also be someone other than the compliance officer.

OMIG recommends that certifying providers/entities conduct a self-assessment of their compliance program and make any necessary adjustments prior to certification. An effective compliance program must include eight fundamental elements:

  1. written policies and procedures describing compliance expectations
  2. designation of an employee to serve as the compliance officer
  3. training and education of employees
  4. communication access to the compliance officer by all employees
  5. disciplinary policies that encourage good-faith participation in compliance efforts
  6. a system for routine identification of compliance risk areas
  7. a system for responding to compliance issues when they arise, and
  8. a policy of non-intimidation and non-retaliation for good-faith participation in the compliance program.

In addition, before certifying with OMIG, all employees and associated persons, including executives and governing body members, must receive annual training and education on compliance issues, expectations and the compliance program. Attendance records and training materials indicating the completion of the required annual training must be maintained by the compliance officer and be readily available for production if requested by OMIG.

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