If you are a HEALTH CARE PROVIDER IN THE STATE OF NEW YORK, you MUST BE AWARE that every healthcare provider billing or ordering over $500,000 per year from the NYS Medicaid program (including claims billed indirectly through third-party managed care organizations (“HMOs”) is required to adopt and implement an effective compliance program. The requirement pertains to services billed directly by the provider as well as any indirect claims such as orders or referrals for ancillary services, claims for which are submitted to Medicaid, including but not limited to laboratory, radiology, and ambulette services. The Compliance Program applies to billings, payments, medical necessity and quality of care, governance, mandatory reporting, credentialing, staffing and other risk areas that are or should, with due diligence, be identified by every healthcare provider.
All providers are cautioned: A provider may be subject to sanctions and penalties, including revocation of enrollment in the NYS Medicaid Program, for failing to implement an adequate compliance program. Putting together a Compliance Program that meets the requirements of the NYS Department of Health and the Office of Medicaid Inspector General involves a comprehensive professional review of your operations and compiling an extensive set of requisite documentation.
The NYS Medicaid Compliance Program must satisfy specific requirements set forth in relevant NYS codes and regulations. When applying for initial provider enrollment in the NYS Medicaid program, in transfer of ownership applications and once per year thereafter, during the month of December, every NYS healthcare provider must demonstrate and certify to the Office of the Medicaid Inspector General that an adequate and effective Compliance Program has been implemented, which includes properly drafted policies and procedures that describe compliance expectations.
December 2012 is an IMPORTANT DEADLINE!! Every NYS healthcare provider claiming over $500,000 per year must CERTIFY to OMIG that an adequate Program is in place by DECEMBER 31, 2012!
Experienced attorneys at the healthcare law firm of Sauchik Law Group, P.C. will take time to address any of your questions pertaining to implementation and certification of an effective Medicaid Compliance program as well as address any other healthcare legal issues you may be facing.