NY Deadline Approaching to Certify Compliance Programs

December 9, 2019 | Rivkin Rounds Staff | Fraud and Abuse | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid

The annual December 31st deadline for certain Medicaid providers and third-party billers to certify as to the effectiveness of their compliance program is fast approaching.

New York State Medicaid providers and third-party billing companies who claim, bill, order or receive at least $500,000 in any consecutive 12-month period from the Medicaid Program or Managed Medicaid payors are required to implement an effective compliance program aimed at detecting and preventing fraud, waste and abuse. In addition, facilities licensed under Article 28 or Article 36 of the New York Public Health Law, which includes hospitals, ambulatory surgery centers, diagnostic and treatment centers and home care agencies, must have a compliance program regardless of the amount they claim, bill, order or receive from Medicaid or Managed Medicaid.

The Office of Medicaid Inspector General (OMIG) recommends that certifying providers/entities conduct a self-assessment of the operation 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 lines to the Compliance Officer that are accessible to all employees;
  5. Disciplinary policies to 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.

Providers and third-party billing companies that are required, yet fail, to certify with OMIG may be subject to administrative sanctions, ranging from censure to termination of the provider’s enrollment in the Medicaid program. OMIG also makes clear in its certification form that “[m]aking a false statement in [the] certification may subject you to criminal prosecution for a misdemeanor or felony under the New York State Penal Law.”

Thus, it is important that providers begin reviewing their policies, if they have not already done so, and certify as to the effectiveness of their compliance programs with OMIG prior to the December 31st deadline. The certification form can be completed online on OMIG’s website.


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