OMIG Effectiveness Review

OMIG’s new regulatory obligations essentially require providers to critically review and revise the compliance program that they already have in place. Failure to do so can lead to consequences, such as recoupment of Medicaid program payments, as OMIG’s new regulations make clear that the adoption, implementation, and maintenance of an effective compliance program is a condition of Medicaid program payment

One of the new OMIG regulations obligate providers to perform an annual compliance program effectiveness review. “The reviews should include on-site visits, interviews with affected individuals, review of records, surveys, or any other comparable method the required provider deems appropriate, provided that such method does not compromise the independence or integrity of the review. The required provider shall document the design, implementation and results of its effectiveness review, and any corrective action implemented. The results of annual compliance program reviews shall be shared with the chief executive, senior management, compliance committee and the governing body.”  See New York Codes, Rules and Regulations Title 18 § 521-1.4(g)(2).

The onset of the fourth quarter is a timely reminder to ensure completion in 2024 of the required effectiveness review and discussion with provider leadership.