Description: The New York State Office of the Medicaid Inspector General presented the first in a series of OMIG Webinars on June 8, 2010. Entitled "Addressing Excluded Persons in Medicaid Employment and Contracting--New York," this session covers New York State and federal laws governing exclusion and provides examples of several cases in which exclusion from the Medicaid program has been applied to individuals.
Description: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA).Under Section 6402 of PPACA, and "person" who has received (either directly or indirectly) an overpayment from the Medicaid program is obligated to "report and return" the overpayment to the state, and to provide an explanation "in writing of the reasons for the overpayment, within 60 days of identification of the overpayment." Failure to do so may expose the "person" to liability under the False Claims Act, including whistleblower actions, treble damages and penalties.
This OMIG Webinar will review the responsibilities of both "persons" and Medicaid providers under this statute, which took effect March 23, 2010. OMIG will begin its audit and enforcement activities under PPACA on January 1, 2011, and this Webinar is designed to provide education and guidance in complying with this significant new obligation.
OMIG will also be soliciting questions from Webinar participants about application and compliance with these requirements in New York Medicaid, in order to develop and respond to frequently asked questions on the OMIG Web site.
OMIG Webinar #4: Provider and Third-Party Payer Obligations: Medicaid Third-Party Billing, Payment and Enforcement
Description: OMIG's next webinar, Provider and Third-Party Payer Obligations: Medicaid Third-Party Billing, Payment and Enforcement, is scheduled for October 20th at 2PM Eastren. The session will discuss the responsibility of health care providers under the third-party liability laws, the effect of Section 6402 of the Patient Protection and Affordable Care Act (PPACA, or the Obama health plan) on providers' and payers' third-party responsibilities and how we "ensure that the medical assistance program is the payer of last resort."
Description: The next Webinar for the Office of the Medicaid Inspector General, "Evaluating Effectiveness of Compliance Programs," will take place on Wednesday, November 17, 2010 at 2 pm. Featured speakers will be Medicaid Inspector General James G. Sheehan, Assistant Deputy Medicaid Inspector General for Compliance Matthew Babcock, and Compliance Specialist Carol Booth.
OMIG Webinar #6 - Ten compliance questions for health care providers and outside billing entities about the use of outside billers to the New York Medicaid program.
Description: New York Medicaid requires that all "persons submitting claims, verifying client eligibility, or obtaining service authorizations for or on behalf of providers" must be enrolled separately in the Medicaid program as a "service bureau" unless the person is an employee of the provider. 18 NYCRR 504.9. In addition, "any provider which "submit (s) claims, verifies client eligibility, or obtain(s) service authorizations for or on behalf of any other entity must enroll as a service bureau in addition to enrolling as a provider of medical care, services, or supplies."
These provisions allow the Medicaid program to identify and address each of the responsible entities when improper billing is discovered, and help assure that an effective compliance program is in place and properly certified for both the health care provider and the billing/verifying entity.
Recent OMIG reviews, and MFCU investigations have identified significant failures of compliance by both third party billing and third party client eligibility entities, and by the health care providers which contract with those entities.
Tracking and monitoring third party entities involved in billing has acquired greater significance with the advent of widespread electronic claim submission and the use of claims consolidators and clearinghouses. The Affordable Care Act, Section 6503, requires that "billing agents, clearinghouses, or other alternate payees that submit Medicaid claims on behalf of health care provider must register with the State and Secretary in a form and manner specified by Secretary, " although the implementing regulations have not yet been issued. New Jersey requires that billing services be enrolled with the Department of Banking and Insurance. N.J.S.A. 17B:27B-1 et seq.