New York State law and regulations require that certain Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste and abuse in the Medicaid program. Under New York's Mandatory Compliance Law, adopting and implementing an effective compliance program when you are required to do so is a prerequisite to being eligible to receive Medicaid payments or to submit claims for care, services or supplies for or on behalf of another person. Not having a compliance plan in place can result in penalties and exclusion from Medicaid, as well as greatly increases the risk of audits and payback requests.
NY pharmacies must have a compliance plan if they bill or claim $500,000 or more from Medicaid in a 12 month period. The $500,000 threshold applies if the provider receives the reimbursement directly or indirectly from Medicaid funds, such as through Medicaid third-party HMOs.
Submit your information online and we will draft your compliance plan, send you customized compliance documents, and submit a certification to the New York Office of the Medicaid Inspector General upon completion. The complete package will be mailed to you along with the required acknowledgement forms and copies for all employees and owners.
Go to E-Compliance Form