NY requires compliance programs for Medicaid providers
Healthcare Auditing Weekly, February 3, 2009
New York Medicaid providers must implement a compliance program according to a new mandate from the New York Office of the Medicaid Inspector General (OMIG).
Medicaid providers who submit, or anticipate submitting, $500,000 in claims in a consecutive 12-month period must comply with the new requirement. According to the language published on the OMIG Web site, approved compliance programs should include all of the following:
- Written policies and procedures
- A designated employee responsible for the day-to-day operation of the compliance program
- Training and education for all affected employees and persons associated with the provider
- Communication lines between the compliance position and all employees, including a method for anonymous and confidential good faith reporting of potential compliance issues
- Policies to encourage good faith participation in the program
- A system to identify compliance risk areas, including internal and external audits, and self-evaluations
- A system for investigating potential compliance problems, as well as correcting the problems and implementing procedures to prevent future issues
- A policy of non-intimidation and non-retaliation for good faith participation in the compliance program
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