New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 521 - Fraud, Waste and Abuse Prevention
Subpart 521-1 - COMPLIANCE PROGRAMS
Section 521-1.5 - Compliance program reviews

(1) the adopted compliance program satisfies the requirements of this SubPart;

(2) the adopted compliance program has been implemented and that the required provider has continuously operated such program for the entire period under review;

(3) that the required provider met the criteria requiring the adoption, implementation and maintenance of such programs; and

(4) the adopted, implemented and maintained compliance program is effective.

(1) OMIG shall notify a required provider of its intent to commence a review of its compliance program by sending the required provider written notification of the review period and procedures for completing the review. The notification shall be sent to the required provider's correspondence or pay-to address on file with the department, or last known address. The notification shall include the legal authority for the review, outline the process and timeframes for completing the review, and list any documentation the required provider must provide.

(2) The required provider shall provide its responses in the form and manner prescribed by OMIG, including any requested records, within thirty (30) days of the date on OMIG's notification of its intent to commence a compliance program review. For good cause shown, OMIG may extend the thirty (30) day period to respond.

(3) The provisions of this section notwithstanding, OMIG may separately review an MMCO's compliance program as part of a Medicaid program integrity review pursuant to subdivision 36 of section 364-j of the Social Services Law.

(1) advise the required provider whether its compliance program satisfactorily met the requirements of this SubPart;

(2) advise the required provider of any recommendations for improving its compliance program or correcting deficiencies; or

(3) where OMIG has determined that a required provider has not satisfactorily met the requirements of Social Services Law section 363-d and the requirements of this SubPart, OMIG will advise the required provider that, in addition to any other action authorized by law, it may be subject to monetary penalties pursuant to Part 516 of this Title, and that its participation in the Medicaid program may be revoked (terminated) pursuant to Part 504 of this Title.