OMIG’s Self-Assessment Compliance Tool

Compliance Audits on the Horizon—Are You Prepared?

By Paul Mayer, MBA, MPA

Last year we all read “The OMIG Who Stole Xmas” published by the New York Nonprofit Press November 30, 2009.  That article discussed the OMIG audit process and its impact on non-profits around the state.   We all understand the impact of the OMIG audits.  At least at this point, we all should be well aware of the OMIG and what is going on in the provider community in New York State and the rest of the country.

Well, ‘tis the season…again. 

“New York State Social Services Law Section 363-d and the corresponding regulations at 18 NYCRR Part 521 require certain providers in the medical assistance program (Medicaid) to have an effective compliance program. The Office of Medicaid Inspector General (OMIG) has the responsibility under Section 363-d to determine if compliance programs meet these requirements.

New York State Social Services Law Section 363-d also requires the OMIG to create and make guidance available on its website to reflect the requirements of mandatory provider compliance programs. OMIG uses Compliance Alerts as one method to provide guidance to Medicaid providers in order to meet the guidance requirements of Section 363-d. Compliance Alert 2010-01 describes the purpose behind OMIG’s publication of Compliance Alerts.”

 – OMIG Compliance Alert 2010-02

As the quote above indicates, the OMIG is obligated to determine if provider compliance programs meet the requirements as well as to create and make available on its website guidance to for the mandatory compliance programs required in the Title 18 Part 521 regulations.  The October, 2010 OMIG Compliance Alert is evidence that the OMIG is following through on their obligations.  The OMIG published a self-assessment tool for you to assess your own compliance program as a first step in fulfilling its obligations.   

The next logical step is for the OMIG to come out and audit your compliance program effectiveness.   Jim Sheehan, New York State Medicaid Inspector General, is very open about the fact that in 2011 his office will begin audits of provider compliance programs.  Are you prepared?  We know the impact of the OMIG audits as they relate to the standards for Medicaid reimbursement…findings, leading to extrapolation, leading to substantial paybacks.  What will be the impact of the compliance program audits?  Do you want to wait to find out? 

The OMIG suggests that one way to determine whether your compliance program is effective or not is to do regular assessments.  You can do this internally utilizing the OMIG’s Self Assessment Tool or one that you have developed on your own, or utilize an external source with knowledge about your particular program regulations and requirements for an unbiased expert opinion. 

Now is not the time to sit and wait, you need to take action and give yourself assurance that your compliance program is up to speed and meets your expectations as well as the expectations of the OMIG.  If you have any questions related to these issues, please don’t hesitate to give us a call at 1-800-487-7624

About the Author:
Paul is a Manager in the Healthcare Compliance Solutions division at The Bonadio Group.  He is a healthcare professional with more than 10 years of experience in not-for-profit settings, and has held positions as a Corporate Compliance Officer, Director of Corporate Compliance, Process Integrity Coordinator, and Case Manager for agencies regulated by OMRDD, OMH, and OASAS.