By Seth A. Nadel, Esq.

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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