NYS OMIG STREAMLINES COMPLIANCE CERTIFICATION REQUIREMENTS

By Mathew J. Levy, Esq. & Zoila Sanchez, J.D., M.P.H.

Effective immediately, the New York State Office of the Medicaid Inspector General (OMIG) implemented changes to the annual Compliance Certification Requirement (NYS Social Services Law (SSL) §363-d) which we discussed in a prior Blast

This change impacts ALL NYSPROVIDERS AND BILLING COMPANIESthathavereceived or billed at least $500,000 in Medicaid payments directly or indirectly (through managed care companies or insurers) in any consecutive 12-month period, as well as prior certification obligations under the Deficit Reduction Act (DRA).

The annual certification requirements have been simplified in the following ways: 

NYS providers are no longer required to complete the annual December certification also known as the SSL Certification, which was previously completed using a form available on the OMIG website. 

Instead, providers and billing companies must now submit an annual Certification Statement to eMedNY. That filing now satisfies and hence eliminates the DRA Certification required for providers billing or receiving over $5 million dollars annually. 

Deadline: The Certification Statement is due on the anniversary of the provider’s Medicaid enrollment. Providers can locate this date in their initial Medicaid enrollment welcome letter. Additionally, providers can expect to receive a NYSDOH reminder by mail approximately 45-60 days before their enrollment anniversary.

Impact: In response to a request for clarification, the OMIG has told us that there will be additional changes in the upcoming months to the financial threshold for Medicaid certification. Those changes will be noticed in Medicaid Updates. We will also provide updates in future Blasts.

Keep in mind that providers who have withdrawn from Medicaid due to sale or closure but are  still collecting Medicaid monies for services rendered prior to withdrawal from the program, will still be required to file if they hit the $500,000 threshold during the relevant time period.

Remember—the recent changes do not alter other requirements which are continuously evaluated by OMIG’s Bureau of Compliance to reduce fraud, waste, and abuse. Providers can take steps to ensure compliance by reviewing “Understanding Compliance.”

Should you have any questions regarding mandatory compliance program requirements please contact Mathew Levy at 516-926-3320 or MLevy@weisszarett.com.

About the Authors: 

Mathew J. Levy is a Partner of the firm and co-chairs the Firm’s corporate transaction and healthcare regulatory practice. Mr. Levy has extensive experience in, defending healthcare professionals in actions brought by State licensing authorities and the Federal agencies (OIG, Medicare, OMIG, Medicaid, DEA, OSHA, OCR OSHA, Hospital Review Boards, Office of Professional Medical Conduct and Office of Professional Discipline.) Mr. Levy has successfully defended numerous healthcare providers in actions involving the US Attorney’s Office investigations, Medicare Fraud Waste and Abuse investigations, Medicaid Fraud Control Unit investigations, OPMC, OPD, Medicare, Medicaid as well as commercial insurance audits including Prepayment Review, Post Payment Review, Medicare Hearings and Hospital Discipline Investigations.

Mr. Levy has successfully structured and negotiated joint venture agreements, private equity transactions, venture capital transactions, stock purchase agreements, asset sale agreements, shareholders agreements, partnership agreements, employment contracts, managed care agreements and commercial leases. Among the areas in which he focuses are coordinating mergers and acquisitions, compliance programs, ambulatory surgery centers, the establishment of diagnostic and treatment centers, HIPAA privacy regulations, fee-splitting issues, Stark law issues, fraud and abuse rules and regulations and Medicare/ Medicaid, Oxford, Americhoice, Fidelis, Healthfirst and other third-party payor settlements.

Zoila Sanchez, J.D., M.P.H. joined the Firm full-time upon graduating with her Juris Doctor degree from the Maurice A. Deane School of Law at Hofstra University. During law school, Ms. Sanchez served as a Legal Clerk with the U.S. Department of Health and Human Services Office of Counsel to the Inspector General in Washington, DC, where her work focused on health care fraud and abuse. Ms. Sanchez has experience in supporting the Firm’s business and health care law, and litigation practice areas. 

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.

ATTORNEY ADVERTISING: PRIOR RESULTS DO NOT GUARANTEE FUTURE OUTCOMES.

QUI TAM/WHISTLEBLOWER SETTLEMENT OBTAINED FOR FIRM CLIENT

Press Release: Weiss Zarett Brofman Sonnenklar & Levy, P.C., represents client in Whistleblower Case against New York City Health and Hospitals Corporation and Former Program Director of the Podiatric Medicine and Surgery Residency Program at Coney Island Hospital, which pays $1.25 million to Settle Lawsuit Alleging Submission of False Claims to Medicare and Medicaid

Brooklyn, New York, September 24, 2020 – The New York City Health and Hospital Corporation (“HHC”) and Glenn J. Donovan, DPM (“Dr. Donovan”), former Program Director of the Podiatric Medicine and Surgery Residency Program at Coney Island Hospital (“CIH”), have agreed to pay $1.25 million under the False Claims Act (“FCA”) to settle a whistleblower case brought by a podiatrist, Irina Gelman, DPM, who alleged that HHC and Dr. Donovan knowingly violated Medicare and Medicaid program requirements in submitting claims for hospital and professional services, and in operating the PMSR program at CIH.

Dr. Gelman’s “qui tam” (whistleblower) lawsuit against HHC and Dr. Donovan was filed in 2012 in federal district court in Brooklyn. Dr. Gelman was represented by the law firms Farrell Fritz, P.C., Kaiser Law Firm, PLLC and Weiss Zarett Brofman Sonnenklar & Levy P.C.

“Dr. Gelman is a medical professional of utmost integrity who refused, at great personal cost and over the course of eight long years, to look away from what she knew were wrongful billing and operational practices inside the podiatry residency program at Coney Island Hospital,” said Geoffrey R. Kaiser, a whistleblower attorney and Principal of Kaiser Law Firm, PLLC. “She never once wavered in her confidence and belief.” 

The whistleblower complaint alleges that HHC and Donovan: (1) submitted or caused to be submitted claims for payment to Medicare and Medicaid, which violated Medicare and Medicaid program requirements governing payment for inpatient and outpatient hospital services for podiatry at CIH, payment for professional podiatrist services furnished by Dr. Donovan, and payment for the costs of direct and indirect graduate medical education relating to the podiatric and surgical residency program for podiatry residents at CIH; (2) violated standards and requirements established by the Council on Podiatric Medical Education governing the podiatric medicine and surgery residency program at CIH; and (3) submitted or caused to be submitted claims for payment for the costs of graduate medical education and indirect medical education, and for hospital and professional services in which certain podiatry residents at CIH participated, during periods when those podiatry residents lacked a Limited Residency Permit established pursuant to § 7008 of the New York Education Law.

Dr. Gelman served as a podiatric resident, including in the position of Chief Resident, in the PMSR program at CIH from July 2010 until in or about late 2013. As a podiatry resident, Dr. Gelman witnessed the improper billing and operational practices that compelled her to commence her whistleblower lawsuit. 

“This case highlights the importance of people being willing to step forward and expose improper conduct and billing involving federal and state funds,” said Kevin P. Mulry, a litigation partner at Farrell Fritz, “particularly where the allegations involve a troubling lack of training and supervision in one of our public hospitals.”  

“From the moment I met Dr. Gelman, I was singularly impressed by her desire to expose institutional wrongs impacting the public fisc,” notes David A. Zarett, Esq., a founding member of Weiss Zarett Brofman Sonnenklar & Levy, P.C., “and her confidence and self-determination to pursue this issue in court rather than look the other way.” 

An important aspect of the case is that Dr. Gelman and her attorneys litigated it entirely on their own to recover federal and state taxpayer money since the government declined to intervene in the qui tam lawsuit.

“The government is frequently the first to point out that a declination does not mean that a case lacks merit, since there are many reasons that the government may sometimes elect not to intervene in a whistleblower case,” Kaiser said.  “We could not be more pleased to have played a part in prosecuting this important case, and to have recovered significant proceeds for taxpayers.”

$1,030,325.00 of the settlement amount will be paid to the United States for Medicare-related conduct and the federal portion of Medicaid-related conduct. $219,675.00 will be paid to New York State for the state portion of Medicaid-related conduct covered under the settlement agreement. 

The federal False Claims Act and similar state laws offer whistleblowers (frequently called “Relators”) protections and rewards to encourage them to file qui tam lawsuits against individuals and entities that are stealing from the government through Medicare fraud and other types of fraud. The laws also allow whistleblowers and their counsel to independently pursue FCA claims on behalf of the government when the government declines to join a qui tam lawsuit, which is what happened in Dr. Gelman’s case. 

Case citation: United States of America, et al., ex rel. Gelman vs. Glenn J. Donovan, DPM, et al., Case No. 12-CV-5142

Mathew J. Levy, Esq. will be speaking at the New York Chiropractic Council 31st Annual Convention

Mathew J. Levy, Esq. will be speaking at the New York Chiropractic Council 31st Annual Convention.

This course looks at the third-party payor audit process and how to avoid being subject to one of these audits. The course will also address what to do when an investigator shows up at the office.

There is perhaps no more frustrating moment in a doctor’s career than when a health plan or managed care company notifies him/her that, after the doctor has spent countless hours and expended endless efforts to get paid fifty or sixty cents on the dollar for services rendered to his/her patients, the payor is now suddenly demanding that some exorbitant amount of money be “repaid” to the payor, or that the payor is not going to pay the doctor for the services rendered and billed until documentation is reviewed. This course will explore the basis for these audits, including retrospective overpayment demands and prepayment audit reviews, as well as the steps involved in responding to these audits to achieve the most favorable results possible.  Furthermore, we will explore how a doctor can reduce his/her odds of being subject to a third-party payor audit, and what to do if an investigator pays an unexpected visit to the doctor’s office.

Time to Congratulate Mathew J. Levy, Esq.!

Congratulations to Mathew J. Levy, Esq.; he has been a member of Thompson Reuter’s Super Lawyers for 10 years!

CONGRATULATIONS TO MICHAEL BROFMAN, ESQ.!

Congratulations to Michael Brofman, Esq. on being selected and featured in the Leading Lawyers Association by the Top Attorneys of North America!