WCH is in compliance with the NYS law. WCH has submitted a certification for the Mandatory Compliance Law for Medicaid providers.
Here is what you need to know about WCH compliance program.
The Mandatory Compliance Law was established by the New York State Office of the Medicaid Inspector General (OMIG), which requires that Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste, and abuse in the Medicaid program. The purpose of this compliance program is to require providers to implement and maintain appropriate systems and processes to detect and prevent fraud, waste and abuse in the Medicaid program. This promotes program integrity in the Medicaid program and saves the Medicaid program dollars by reducing inappropriate payments and maximizing appropriate payments for covered services that are delivered to Medicaid recipients.
The compliance program is required for other persons, providers or affiliates who provide care, services or supplies under the Medicaid program, or who submit claims for care, services or supplies for or on behalf of another person for which Medicaid is, or should be reasonably expected by the provider to be a substantial portion of their business operations.
Under this classification WCH meets the description and therefore by law, must have a compliance program in place and must conform to the mandatory compliance program obligation.
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What does WCH Compliance program contain?
Written policies and procedures that describe compliance expectations as embodied in a code of conduct or code of ethics, implement the operation of the compliance program, provide guidance to employees and others on dealing with potential compliance issues:
1. Designated employee vested with responsibility for the day-to-day operation of the compliance program;
2. Training and education of all affected employees and persons associated with the provider;
3. Communication lines to the responsible compliance position are accessible to all employees, persons associated with the provider, executives, and governing body members, to allow compliance issues to be reported;
4. Disciplinary policies to encourage good faith participation in the compliance program by all affected individuals, including policies that articulate expectations for reporting compliance issues and assisting in their resolution;
5. A system for routine identification of compliance risk areas specific to the provider type, for self-evaluation of such risk areas;
6. A system for responding to compliance issues as they are raised; for investigating potential compliance problems; responding to compliance problems as identified in the course of self-evaluations and audits; correcting such problems promptly and thoroughly and implementing procedures, policies and systems as necessary to reduce the potential for recurrence; identifying and reporting compliance issues to the department or the office of Medicaid inspector general; and refunding overpayments;
7. A policy of non-intimidation and non-retaliation for good faith participation in the compliance program.
Should you have any questions regarding our policies please contact our compliance officer Anna Kim at Annakim@wchsb.com