Fidelis Care is sending out an important reminder regarding the implementation of new compliance program requirements for participating Medicaid providers, as mandated by the Office of the Medicaid Inspector General (OMIG).
Commencing in April 2020, as stipulated by the New York State (NYS) Social Services Law (SSL) §363-d, and from December 28, 2022, per the corresponding regulations at 18 New York Codes, Rules, and Regulations (NYCRR) Subpart 521-1, Medicaid providers in New York State are obligated to establish, institute, and maintain effective compliance programs that target the detection of fraud, waste, and abuse within the NYS Medicaid program.
Who is Required to Have a Compliance Program?
The determination of providers mandated to implement a compliance program is governed by NYS Social Services Law (SOS) § 363-d and Title 18 of the New York Codes, Rules, and Regulations (18 NYCRR) SubPart 521-1.
If your organization answers YES to any of the following criteria, it is required to establish a compliance program in New York State:
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