New York state regulations effective October 1, 2009, will require health care providers in New York to have an effective compliance program in place if they receive more than a $500,000 from the state's Medicaid program. These regulations will expand the reach of the Deficit Reduction Act of 2005, which requires providers who receive more than $5 million from the Medicaid program to enact compliance plans regarding the False Claims Act and whistleblowers.
A required provider's compliance program must include the following elements: (1) written policies and procedures that describe compliance expectations; (2) designation of an employee vested with responsibility for the day-to-day operation of the compliance program; (3) training and education of all affected employees and persons associated with the provider; (4) communication lines to the employee designated in (2) above; (5) disciplinary policies that outline sanctions for: (i) failing to report suspected problems; (ii) participating in non-compliant behavior; or (iii) encouraging, directing, facilitating or permitting either actively or passively non-compliant behavior; (6) a system for routine identification of compliance risk areas specific to the provider type; (7) a system for responding to and investigating compliance issu es as they are raised; and (8) a policy of non-intimidation and non-retaliation for good faith participation in the compliance program.
The New York Commissioner of Health and its Medicaid Inspector General will have the authority to determine if a compliance plan is effective. A provider may be subject to sanctions or penalties for failing to have an effective compliance plan, including revocation of the provider's agreement to participate in Medicaid.