Many New York State healthcare providers have recently felt the heavy hand of the state enforcement agency as the Office of Medicaid Inspector General (OMIG) seeks to recoup payments paid out to providers in an effort to eliminate fraud, waste and abuse in the healthcare industry. At a recent presentation given by OMIG, the agency identified the following core requirements for all healthcare providers that participate in the Medicaid program:
(a) to prepare and to maintain contemporaneous records demonstrating the provider’s right to receive payment;
(b) to keep those records for a period of six years from the date the care, services or supplies were furnished;
(c) furnish such records upon request;
(d) accept payment from the medical assistance program as payment in full for all care, services and supplies billed under the program;
(e) bill for services actually furnished and which were medically necessary;
(f) permit audits of all books and records relating to services furnished and payments received;
(h) that the information provided in relation to any claim for payment shall be true, accurate and complete; and
(i) to comply with the rules, regulations and official directives of the department.
For more information see 18 NYCRR 504.3 and contact an attorney knowledgeable in this area.