February 26, 2015


I received a letter from the NYS Office of Medicaid Inspector General inquiring whether I have a compliance plan and asking why I did not certify I have one.  Now what do I do?  What is a compliance plan?  Do I need one?  How did they find me? Please help. 

Dr. G


Dr. G, good questions.  It's true, the NYS Office of Medicaid Inspector General has started checking whether practices are complying with the requirement that they have a compliance program.  This requirement went into effect in July 2009, and it seems for the first time letters have gone out to practitioners required to abide by the requirement to see why they have not certified their plans. How is Medicaid finding you?  Well, its pretty simple, any NYS practitioner that bills or orders more than $500,000 of Medicaid payable services, whether straight Medicaid or Medicaid-HMO is required to have a compliance plan and to certify they have one. So, its all computerized and easily trackable whether you are required to have one, and whether you've actually certified.  So, you received a letter, now what?  Well, now if you don't have a compliance plan, you need one, and you need to certify you got one.  

So, you've come to the right place.  As a member of our listserv, you may recall we've written on this topic a few times, and, yes, we can help you with a compliance plan.  You may have marginally missed the time frame for preventative adoption, but you still have time to get up to speed before facing potential audit or investigation by OMIG.  Also on a positive note, a compliance plan is a good thing, one that may help you operate more efficiently, bill safer and keep you out of trouble.  So, once you adopt a plan, abide by it!

Compliance Plan Order Form

For prior OMIG/Compliance Plan articles, visit our archive page.

Questions?  Contact Jennifer@Kirschenbaumesq.com or (516) 747-6700 x. 302 or Erica at EYoungerman@kirschenbaumesq.com or (516) 747-6700 x. 308..

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