Tag Archives: Compliance

UPDATE: OMIG Releases Revised Compliance Guidance to OASAS Providers

The Office of the Medicaid Inspector General (“OMIG”) has issued Revised Compliance Guidance for use by providers regulated by the New York State Office of Alcoholism and Substance Abuse Services (“OASAS”). 

The revision clarifies that the Compliance Guidance examples are taken from OMIG Audit Protocols for OASAS Chemical Dependence Programs and Services for dates of service prior to the date that the Ambulatory Patient Group (“APG”) regulations (14 NYCRR Part 822) went into effect.  Once OMIG audit protocols are developed for the APG reimbursement system, OMIG may update this compliance alert.

Check out our original post for more information about this Compliance Guidance.

The Revised OMIG Compliance Guidance for OASAS providers is available here.

Kathleen Evers wrote this post.  For more information, please contact David R. Ross, who served as Acting New York State Medicaid Inspector General under governors Pataki and Spitzer, as well as General Counsel, Deputy Medicaid Inspector General, and Director of Audits and Investigations for the Office of the Medicaid Inspector General.  Prior to his service at the OMIG, David held several positions at the New York State Office of Alcoholism and Substance Abuse Services, including Acting General Counsel, Deputy Counsel, and Associate Counsel.  He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.

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Filed under NY Office of Medicaid Inspector General

Attention OPWDD Providers: OMIG Releases Compliance Guidance for Corporate Compliance Programs

The New York State Office of the Medicaid Inspector General (OMIG) has released Compliance Guidance for use by providers regulated by the New York State Office of Persons for Developmental Disabilities (OPWDD).

The routine identification of compliance risk areas, relating to the particular type of services being offered by Medicaid providers, is required for certain providers in accordance with the New York State Social Services Law Section 363-d and implementing regulations at 18 NYCRR Part 521. The purpose of the OMIG’s Compliance Guidance is to give examples of compliance risk areas that may be of particular concern to those providing Day Habilitation, Day Treatment, Residential Habilitation, and Medicaid Service Coordination services. Many of these are taken from OMIG Audit Protocols for Office for People with Developmental Disabilities (OPWDD) programs and services which can be found on OMIG’s Web site at www.omig.ny.gov.

The OMIG Compliance Guidance for OPWDD providers is viewable here.

For more information, please contact the author, David R. Ross, who served as Acting New York State Medicaid Inspector General under governors Pataki and Spitzer, as well as General Counsel, Deputy Medicaid Inspector General, and Director of Audits and Investigations for the Office of the Medicaid Inspector General (OMIG). He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.

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Filed under NY Office of Medicaid Inspector General

New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled

On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated  facilities for the developmentally disabled received $1.7 billion in Medicaid payments in excess of the reported costs of these facilities. The Medicaid rates paid to these New York State-operated facilities were ten times higher than the rates paid to private Intermediate Care Facilities in New York, which the OIG found comparable. The OIG determined that these overpayments had occurred for two decades and that they are still occurring in 2012. In fact, in fiscal year 2011, the daily payment rate to New York’s developmental centers was $5,118, which represented a 24 percent increase since 2009 and means that State-run developmental facilities are being paid approximately $1.9 million per year for each individual patient. This surprising increase was triggered by the formula for Medicaid payment rates for patients in developmental centers, which allows State-operated facilities to collect roughly two-thirds of the total Medicaid payment after an individual who has left the facility. Continue reading

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud, Uncategorized

OMIG Releases Compliance Alert for Medicaid Providers

The New York State Office of Medicaid Inspector General (“OMIG”) recently released a Compliance Alert that explains what types of Medicaid providers are required to have a compliance program and what steps those providers can take to ensure that they are meeting their obligations under the law.

The New York Social Services Law and its implementing regulations require certain Medicaid providers to develop, adopt, and implement effective compliance programs, which are designed to detect and prevent inaccurate billing and inappropriate practices in the Medicaid program (“Mandatory Compliance Law”).  N.Y. Soc. Serv. Law § 363-d; 18 N.Y.C.R.R. Part 521.

This Mandatory Compliance Law applies to Medicaid providers operating under Articles 28 or 36 of the Public Health Law or Articles 16 or 31 of the Mental Hygiene Law, or who are newly enrolled in the Medicaid program.  It also applies to providers of care, services, and supplies for which the Medicaid program is or reasonably should be expected to be a “substantial portion of their business operations.”  The regulations define a “substantial portion” as ordering, billing or claiming $500,000 or more from Medicaid during a 12-month period.  The $500,000 threshold applies whether the provider receives the reimbursement directly or indirectly from Medicaid funds.    Continue reading

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Filed under Announcements, NY Office of Medicaid Inspector General

OMIG Compliance Alert Addresses Medicaid Compliance Program Effectiveness

On July 5, 2011, the New York State Office of the Medicaid Inspector General (OMIG) issued a Compliance Alert (No. 2011-06) addressing Medicaid compliance program effectiveness and providing a Documentation Review Checklist to guide providers in documenting the effectiveness of their compliance programs. Continue reading

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Filed under Announcements, Medicaid Fraud