Health Law Blog

As we have previously written, and as many of you may know, NY mandatory Medicaid compliance law requires that providers who bill, receive or order more than $500,000 from Medicaid must have a compliance program in place.  The Office of the Medicaid Inspector General ("OMIG") requires all affected providers to certify in December of each year that an effective compliance program is in place. 

Recently, OMIG began to conduct "effectiveness reviews"  where it contacts a provider who is supposed to have an effective compliance program, and requires them, sometimes on an expedited basis, to complete the relevant OMIG effectiveness questionnaire and provide other documentation to the compliance effectiveness review team. A site visit may occur, which includes interviews of board members, management and staff and can last a week.  If the effectiveness review team determines that the program is not effective and is not being used, the provider may be found in violation of the compliance law with penalties ranging from fines to potential exclusion.

It is therefore exceptionally important to have a compliance program in place, to follow all certification requirements, and to complete the relevant questionnaire in case of an effectiveness review.  We can help with every step of this process.