NY’s OMIG Finds Basic Compliance Program Gaps

The Bureau of Compliance (BOC) within the New York State Office of the Medicaid Inspector General (OMIG) recently performed an assessment of providers’ compliance programs. The results indicate that providers sometimes fail in relatively less complicated and readily addressable ways.

The Bureau of Compliance is charged with educating and auditing providers in meeting their mandatory compliance program requirement. The recent BOC’s program assessment covered a period between January 2015 and June 2017. By law providers’ compliance program components have to apply to eight areas: 1) billings; 2) payments; 3) medical necessity and quality of care; 4) governance; 5) mandatory reporting; 6) credentialing and 7) other risk areas that are or should with due diligence be identified by the provider.

The compliance program components include: 1) having written policies and procedures; 2) designating an employee vested with responsibility; 3) training and educating; 4) open lines of communications to the responsible compliance position; 5) disciplinary policies; 6) a system for routine identification of compliance risk areas; 7) a system for responding to compliance issues; and 8) a policy of non-intimidate and non-retaliation.

Providers big and small who are required by law to have a compliance program must certify on an annual basis every December their compliance with the compliance program requirement.

BOC’s audit results are noteworthy in that they demonstrate avoidable provider gaps. For example, 55% of providers audited failed to meet the training and educating component. Forty-seven percent did not include training as part of the orientation for employees, executives, governing body members as well as persons associated with providers.

Surprisingly, 47% of providers insufficiently met the requirement of anonymous reporting of compliance issues. Similarly, 44% of providers audited had insufficiently met the requirement of having a non-intimidation policy.

If you have questions about the recent BOC provider compliance program assessment or have other health law related questions please contact our office.