Providers
who bill $500,000.00 or more to the New York Medicaid program in any
12-month period should be aware that, pursuant to Social Services Law §
363-d, 18 NYCRR Part 521, and the Deficit Reduction Act of 2005, they
are required to adopt and implement a compliance program targeted at
identifying and eliminating fraud and abuse. Each December, every such
provider must continually certify that a compliance program remains in
effect and complies with applicable law. Note that the compliance
program requirement also applies to third-party billing companies which
submit $500,000.00 or more in Medicaid claims on behalf of others during
a 12-month period.
Providers and billing companies who fail to
maintain an effective compliance program or fail to certify the same
before the December 31st deadline may be subject to penalties imposed by
the Office of the Medicaid Inspector General (“OMIG”). Penalties could
include administrative sanctions which could jeopardize a provider’s
participation status in the New York Medicaid program, or even criminal
penalties in the event a provider certifies that they have implemented
an effective compliance program when they have not.
OMIG provides
online portals in which providers can submit the necessary
certifications, and provides additional information regarding the annual
compliance certification requirement, at https://omig.ny.gov/compliance/compliance-certification.
Weiss
Zarett routinely represents health care providers in various regulatory
compliance matters. If you are a healthcare provider or biller who
claims or receives over $500,000.00 in reimbursements from the New York
Medicaid program and have not yet implemented the required compliance
program or certified that program with the state, please do not hesitate
to reach out and we will be happy to assist you.
Weiss Zarett
Brofman Sonnenklar & Levy, P.C. is a Long Island law firm providing a
wide array of legal services to the members of the health care
industry, including corporate and transactional matters, civil and
administrative litigation, healthcare regulatory issues, bankruptcy and
creditors’ rights, and commercial real estate transactions.
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