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Certification for December 2011:Certification for December 2011: What Every Provider Needs to Know aboutWhat Every Provider Needs to Know aboutChanges to the OMIG Certification ProcessChanges to the OMIG Certification Process

November 14, 2011November 14, 2011

Presented by:Presented by: Matthew Babcock, JD, FACHE – Assistant Medicaid Inspector General - Bureau of ComplianceMatthew Babcock, JD, FACHE – Assistant Medicaid Inspector General - Bureau of Compliance Carol Booth, RN, CHC – Health Systems Specialist 3 - Bureau of ComplianceCarol Booth, RN, CHC – Health Systems Specialist 3 - Bureau of Compliance

JAMES C. COXActing Medicaid Inspector General

ANDREW M. CUOMOGovernor

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Fighting Fraud. Improving Integrity through a Cooperative Approach. Saving Taxpayer Dollars

If you have a question ask it—someone else probably If you have a question ask it—someone else probably wants to know the answer.wants to know the answer.

If you find these slides useful, please use them.If you find these slides useful, please use them. Program integrity is a developing field so Program integrity is a developing field so expectexpect

changes. changes. OMIG expects the certification process to continue OMIG expects the certification process to continue

to improve, so annual changes are likely.to improve, so annual changes are likely.

The Fine PrintThe Fine Print

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Provide a high-level overview of the federal requirement on Provide a high-level overview of the federal requirement on Medicaid providers that they certify that they meet the Medicaid providers that they certify that they meet the requirements of the Deficit Reduction Act of 2005 (DRA) and requirements of the Deficit Reduction Act of 2005 (DRA) and how providers can meet that requirement in NYS. how providers can meet that requirement in NYS.

Provide a high-level overview of New York State’s Provide a high-level overview of New York State’s requirement that Medicaid providers certify annually that requirement that Medicaid providers certify annually that they have an effective compliance program. they have an effective compliance program.

Describe the form that providers must use to meet their Describe the form that providers must use to meet their certification requirement for 2011 (NYS) and 2012 (DRA). certification requirement for 2011 (NYS) and 2012 (DRA).

Address any questions on New York’s new certification form. Address any questions on New York’s new certification form.

Goals of the PresentationGoals of the Presentation

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Bureau of ComplianceBureau of ComplianceMissionMission

Mission Statement of the Office of Medicaid Inspector Mission Statement of the Office of Medicaid Inspector General (from OMIG Vision Plan)General (from OMIG Vision Plan)Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high quality patient care.

Mission Statement of the Office of Medicaid Inspector Mission Statement of the Office of Medicaid Inspector General’s Bureau of Compliance General’s Bureau of Compliance To educate, assist and assess Medicaid program providers in meeting their obligation to establish and operate effective compliance plans that will prevent or, in the alternative, detect and address fraudulent, wasteful and abusive practices within the Medicaid program.

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Deficit Reduction Act of 2005 Deficit Reduction Act of 2005 ObligationsObligations

The DRA requires health care entities which receive or make $5 million or more in Medicaid payments during a federal fiscal year (October 1 to September 30) to do the following:

establish written policies and procedures informing and educating their employees, contractors and agents about federal and state false claims acts and whistleblower protections.

on or before January 1 of each year, required health care entities are required to certify:

- that it maintains the written policies;- that any employee handbook includes materials, required under the

DRA mandate;- that the materials have been properly adopted and published by the health care entity; and - that the materials have been disseminated to employees, contractors

and agents.

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Deficit Reduction Act of 2005 Deficit Reduction Act of 2005 Obligations Obligations (cont.)(cont.)

Oversight of the DRA certification process has been a requirement of OMIG since it first went into existence in 2007.

OMIG has guidance on its Web site (www.omig.ny.gov). See the Compliance tab and look for Certification

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NYS Compliance ObligationsNYS Compliance ObligationsProviders required to have compliance programs:Providers required to have compliance programs:

New YorkNew York requirements requirements

• those subject to Articles 28 and 36 of the Public Health Law (hospitals, clinics, those subject to Articles 28 and 36 of the Public Health Law (hospitals, clinics, home care, etc.);home care, etc.);

• those subject to Articles 16 and 31 of the Mental Hygiene Law (OMH, OPWDD, those subject to Articles 16 and 31 of the Mental Hygiene Law (OMH, OPWDD, OASAS, etc.); and OASAS, etc.); and

• those that claim, order or receive payment for services or supplies those that claim, order or receive payment for services or supplies directly or directly or indirectlyindirectly; or submit claims for at least $500,000 in a year…; or submit claims for at least $500,000 in a year…

18 NYCRR Section 521.318 NYCRR Section 521.3

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Medicaid Provider Compliance ObligationsMedicaid Provider Compliance ObligationsCertification RequirementCertification Requirement

NYS Social Services Law Section 363-d 3:

(b) Upon applying for enrollment in the medical assistance program, and during the month of December each year thereafter, a required provider shall certify to the department, using a form provided by the Office of the Medicaid Inspector General on its Web site, that a compliance program meeting the requirements of this Part is in place. The Office of the Medicaid Inspector General will make available on its website compliance program guidelines for certain types of required providers.

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What’s New this YearWhat’s New this Year

Much of the data being obtained is not new. Information on service bureaus being used by

Medicaid providers is being captured. Those that are not able to certify that they

have an effective compliance program will be able to provide the information requested on the same form.

There is a link to instructions.

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Suggestions for a Successful and Suggestions for a Successful and Effective Certification ProcessEffective Certification Process

1. Identify the Federal Employer Identification Number (FEIN) that you bill or receive Medicaid payments through. Some providers have multiple FEINs.

2. The Certification must be made on every FEIN that bills or receives a Medicaid payment. Much of the data being obtained is not new.

3. Review your compliance program to ensure that it meets all eight elements of the NYS Social Services Law and the regulations.

4. Assess whether your compliance program is effective.

5. Identify the appropriate person to be the certifying official – someone who the compliance function reports to is ideal.

6. Complete the certification early in December – do not wait until December 31.

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How to fill out the How to fill out the Certification FormsCertification Forms

Successfully Successfully

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RemindersReminders

Use the correct FormUse the correct Form Use the correct FEINUse the correct FEIN Use multiple forms for multiple FEINsUse multiple forms for multiple FEINs Do not certify early wait until December Do not certify early wait until December Remember this is an official documentRemember this is an official document

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Other Ways to Participate with OMIGOther Ways to Participate with OMIG Compliance e-mail; Compliance e-mail; [email protected]@omig.ny.gov Join our listserv; receive information about upcoming Join our listserv; receive information about upcoming

events events (sign-up information on OMIG home page)(sign-up information on OMIG home page)

Follow us on Twitter: NYSOMIGFollow us on Twitter: NYSOMIG Linked-InLinked-In Corporate integrity agreements, Corporate integrity agreements, Compliance AlertsCompliance Alerts

and compliance check listsand compliance check lists Audit reports, positive reports and protocolsAudit reports, positive reports and protocols Excluded provider listExcluded provider list And much more on http://www.omig.ny.govAnd much more on http://www.omig.ny.gov

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How Do You Report Allegations To OMIG?How Do You Report Allegations To OMIG?

Fraud call graphic

Letter Graphic

Fraud Hotline 1-877-87- FRAUD (1-877-873-7283)

Email us at: [email protected]

NYSOMIGNYSOMIG800 North Pearl Street800 North Pearl Street

Albany, NY 12204Albany, NY 12204

PHONEPHONE EMAILEMAIL MAILMAIL

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QuestionsQuestions

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Documents

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