In the article, the authors offer guidance for health care organizations and their boards on how to judge the effectiveness of their compliance programs. Using New York’s Office of the Medicaid Inspector General’s (OMIG) significant changes to mandatory compliance program requirements as a guidepost, the authors summarize certain key amendments to 18 NY Codes, Rules and Regulations Part 521-1, which repealed the former regulations governing compliance programs for providers to detect and prevent fraud, waste, and abuse in the Medicaid program, as well as changes to the self-disclosure program.
The authors assess notable definition changes, compliance program elements, contracting requirements, the self-disclosure program, and the potential for the New York framework to have national applications.
“Providers should monitor this matter and OMIG’s continued enforcement going forward,” the authors conclude.
