Significant Changes to Simplify the OMIG Annual Compliance Certification Process

The New York State Office of the Medicaid Inspector General (OMIG) instituted changes to its annual compliance certification process, effective immediately. These changes apply to those Medicaid, Managed Medicaid, and Service Bureau providers subject to the mandatory compliance program requirements in Section 363-d of the New York State Social Services Law (SSL) and the Deficit Reduction Act (DRA).

Affected providers no longer need to certify compliance in the previously required annual December certification on the OMIG website. The compliance certification requirements of the SSL are now rolled into the Certification Statement for Provider Billing Medicaid which must be completed yearly, prior to the annual anniversary of a provider’s enrollment. Approximately 45-60 days prior to the anniversary of each provider’s enrollment, the Department of Health will mail to the provider a package of information and materials, including the Certification Statement.

Also, requirements under the DRA have been incorporated into the SSL, eliminating the prior separate DRA certification requirement. By submitting the Certification Statement for Provider Billing Medicaid, a provider will attest that it is meeting the requirements of both the SSL and the DRA.

Despite the consolidation of forms, there is no less of an obligation for affected providers to ensure compliance with the requirements of the SSL and the DRA. All providers subject to the SSL are reminded that failure to maintain an effective compliance program may subject the provider to sanctions, including revocation of the provider’s participation in the Medicaid program, or monetary penalties up to $10,000 per calendar month that the provider has failed to adopt and implement a compliance program.

Providers should review their initial enrollment application to determine the anniversary date by which annual certification will be required and should continue to ensure that the elements of a compliance program are being met, including applicable compliance training and education requirements.

This post was co-authored by Joseph P. DiBella, a law school graduate who is not yet admitted to the New York State Bar.