§ 363-d. Provider compliance program. 1. The legislature finds that\nmedical assistance providers may be able to detect and correct payment\nand billing mistakes and fraud if required to develop and implement\ncompliance programs. It is the purpose of such programs to organize\nprovider resources to resolve payment discrepancies and detect\ninaccurate billings, among other things, as quickly and efficiently as\npossible, and to impose systemic checks and balances to prevent future\nrecurrences. The legislature accordingly declares that it is in the\npublic interest that providers within the medical assistance program\nimplement compliance programs. The legislature also recognizes the wide\nvariety of provider types in the medical assistance program and the need\nfor compliance programs that reflect a provider's size, complexity,\nresources, and culture. For a compliance program to be effective, it\nmust be designed to be compatible with the provider's characteristics.\nAt the same time, however, the legislature determines that there are key\ncomponents that must be included in every compliance program and such\ncomponents should be required if a provider is to be a medical\nassistance program participant. Accordingly, the provisions of this\nsection require providers to adopt effective compliance program\nelements, and make each provider responsible for implementing such a\nprogram appropriate to its characteristics.\n 2. Every provider of medical assistance program items and services\nthat is subject to subdivision four of this section shall adopt and\nimplement a compliance program. The office of Medicaid inspector general\nshall create and make available on its website guidelines, which may\ninclude a model compliance program, that reflect the requirements of\nthis section. Such compliance programs shall meet the requirements\nincluded in this subdivision as a condition of payment from the medical\nassistance program. The compliance program required pursuant to this\nsection may be a component of more comprehensive compliance activities\nby the medical assistance provider so long as the requirements of this\nsection are met. Every provider shall adopt and implement an effective\ncompliance program, which shall include measures that prevent, detect,\nand correct non-compliance with medical assistance program requirements\nas well as measures that prevent, detect, and correct fraud, waste, and\nabuse. The compliance program shall include the following requirements:\n (a) Written policies, procedures, and standards of conduct that:\n (1) articulate the organization's commitment to comply with all\napplicable federal and state standards;\n (2) describe compliance expectations as embodied in the standards of\nconduct;\n (3) implement the operation of the compliance program;\n (4) provide guidance to employees and others on dealing with potential\ncompliance issues;\n (5) identify how to communicate compliance issues to appropriate\ncompliance personnel;\n (6) describe how potential compliance issues are investigated and\nresolved by the organization;\n (7) include a policy of non-intimidation and non-retaliation for good\nfaith participation in the compliance program, including but not limited\nto reporting potential issues, investigating issues, conducting\nself-evaluations, audits and remedial actions, and reporting to\nappropriate officials; and\n (8) all requirements listed under 42 U.S.C.1396-a(a)(68).\n (b) Designation of a compliance officer and a compliance committee who\nreport directly and are accountable to the organization's chief\nexecutive or other senior management.\n (c)(1) Each provider shall establish and implement effective training\nand education for its compliance officer and organization employees, the\nchief executive and other senior administrators, managers and governing\nbody members.\n (2) Such training and education shall occur at a minimum annually and\nshall be made a part of the orie
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.