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We wish to remind our clients who receive more than $500,000 from New York Medicaid that they are obligated to adopt a written compliance plan and certify to the New York Office of the Medicaid Inspector General ("OMIG") that the plan has been adopted and is effective. The deadline to certify to OMIG was December 31, 2011, but providers are encouraged to certify as soon as possible even if they missed the deadline. Certification is mandatory, and providers who fail to certify are subject to sanctions up to and including exclusion from the Medicaid program. Providers must certify the following with OMIG:
This form must be completed in December of each year by all Medicaid providers who order, receive or bill $500,000 or more in Medicaid services or supplies within a 12-month period, as well as any Medicaid provider operating under Articles 28 or 36 of the Public Health Law or Articles 16 or 31 of the Mental Hygiene Law. By submitting this certification, a provider attests that it has adopted, implemented and maintained an effective compliance program that meets the requirements of New York State Social Services Law § 363-d and 18 NYCRR Part 521.
Providers who receive or make $5 million or more in Medicaid payments during the federal fiscal year are required to annually certify that they are in compliance with the Federal Deficit Reduction Act (DRA) of 2005, which requires such providers to establish and implement written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections.
To all Medicaid providers:
In accordance with new federal rules and regulations, the New York State Medicaid program will be rolling out the provider revalidation process.
Revalidation will include attestation of credentials as well as the agreement to abide by the rules and regulations of the Medicaid program. Certain provider types will be required to pay a fee for revalidation. A revalidation process will be initiated by the New York Department of Health in the fall of 2012. Revalidation will be rolled out by provider type. Correspondence will be sent to providers, advising them of their need to revalidate their enrollment. Providers will then have 150 days from receipt of the notice to complete the process. Failure to comply with the revalidation and attestation within the timeframe will result in provider disenrollment.
Our firm will assist new and existing clients with Medicaid revalidation. Further updates will be provided when they become available, including a preliminary list of required documentation.
Providers are reminded that they are obligated to complete a compliance package if they bill more than $500,000 to NY Medicaid program annually (including through third-party Medicaid HMOs). We expect that one of the required documents for Medicaid revalidation will be a certification of compliance. We will provide a 20% discount to all clients who retain our firm to prepare a compliance package within the next 30 days after the publication of this announcement (through March 3, 2012). Please contact us as soon as possible if you do not have a compliance package in place as this might result in substantial penalties, puts you at a much higher risk of Medicaid audit, and will prevent you from revalidating your Medicaid enrollment.