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  • Helen A. Zamboni

Legal Alert: Medicaid Compliance Certification

Effective October 1, 2009, any entity that received $500,000 or more in reimbursements from New York Medicaid were required to have in place a corporate compliance program covering at least the following elements:

  • A written code of conduct or code of ethics for employees and others dealing with the entity;

  • The appointment of an individual to act as the entity’s “compliance officer”, responsible for the day-to-day operation of the compliance program;

  • Training of employees and others, including the members of the entity’s governing board, in the applicable laws, rules, regulations and the entity’s compliance program;

  • Development and communication of the systems and procedures to be followed when a violation of the compliance program is suspected, including the protection of the identity of anyone reporting a suspicion, investigation of reports and corrective actions if problems are discovered, self-reporting to NYS Office of Medicaid Inspector General (OMIG) and repayment of overpayments;

  • Policies to ensure compliance with the program and that those reporting suspicions will be not retaliated against or intimidated; and

  • A process for routine self-evaluation of areas of potential risk and development of procedures to address same.

Each affected entity was to make a written certification to OMIG that it had such a compliance program in place on or before December 1, 2009. This certification is to be made annually, on or before December 1 of each year. Affected entities should now be scrutinizing their compliance programs to assure they continue to meet OMIG’s requirements and then submit their certifications.


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