Are Mandated Compliance Programs A New Trend?

New York Medicaid Inspector General Mandates Compliance Programs

Although compliance programs have traditionally been viewed as voluntary, on January 14, 2009, the Office of Medicaid Inspector General issued proposed regulations mandating the establishment and maintenance of compliance programs for many Medicaid participating providers. In addition to applying to certain providers like hospitals and hospices, the regulations include physician practices to the extent the medical assistance program is or should be reasonably expected by a physician practice to be a substantial portion of their business operations. Substantial portion of business operations includes collections of $500,000 for a consecutive 12-month period as well as providers who claim or are expected to claim at least $500,000 in a consecutive 12-month period from the New York medical assistance program. It is not clear as to meaning of “claim”; however, an inquiry has been submitted to the regulators requesting clarification on this issue. While this particular regulation only applies to New York providers, you should continue to monitor regulatory activities in your state to determine whether the mandating of compliance programs will be a trend with regard to Medicaid programs. This new proposed regulation, along with the expected increase in Medicare auditing for 2009, continues to highlight the importance of physician groups (as well as other health care providers like hospices, DME suppliers and others) maintaining active compliance programs.

For more information regarding Compliance, please call Abby Pendleton, Esq., Carey F. Kalmowitz, Esq., Jessica L. Gustafson, Esq., or Adrienne Dresevic, Esq. at (248) 996-8510, visit The HLP website’s Compliance and HIPAA page, or visit The HLP website.