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 521-2 - MEDICAID MANAGED CARE FRAUD, WASTE AND ABUSE PREVENTION
Section 521-2.3 - MMCO duties

Universal Citation: 18 NY Comp Codes Rules and Regs § 521-2.3

Current through Register Vol. 46, No. 39, September 25, 2024

(a) General. MMCOs shall adopt and implement policies and procedures designed to detect and prevent fraud, waste and abuse. Such policies and procedures shall satisfy the requirements of this SubPart. The MMCO's fraud, waste, and abuse prevention program may be a component of more comprehensive fraud, waste and abuse prevention activities by the MMCO, so long as the requirements of this SubPart are met.

(b) Record retention, access to records and facilities, and cooperation with OMIG, Department and MFCU requests. In addition to the MMCO's record retention obligations under the MMCO's contract with the department to participate as an MMCO, an MMCO shall retain all records demonstrating that it has adopted, implemented and operated a fraud, waste and abuse prevention program which has satisfied the requirements of this SubPart.

(1) The MMCO and its subcontractors shall retain records in accordance with the requirements of its contract with the department to participate as an MMCO.

(2) The MMCO and its subcontractors shall provide to OMIG, the department or their authorized representatives, and MFCU, all records and information requested, in the form requested, and allow access to their facilities at any time. All copies of records must be provided free of charge. The MMCO and its subcontractors shall comply with any additional terms regarding access to records in accordance with the terms of its contract with the department to participate as an MMCO.

(3) The MMCO and its subcontractor shall permit OMIG, the department and MFCU to conduct private interviews of MMCO personnel, its subcontractors and their personnel, witnesses, and enrollees. MMCO personnel, and subcontractors and their personnel must cooperate fully in making MMCO personnel, subcontractors and their personnel available in person for interviews, consultation, grand jury proceedings, pre-trial conferences, hearings, trial and in any other process, including investigation, at the MMCO's and subcontractor's own expense.

(c) Contractors, agents, subcontractors, and independent contractors. MMCOs shall ensure that contracts with contractors, agents, subcontractors, independent contractors, and participating providers specify that the contractors, agents, subcontractors, independent contractors, and participating providers are subject to audit, investigation, or review under the MMCO's fraud, waste and abuse prevention program, to the extent that such contractors, agents, subcontractors, independent contractors, and participating providers relate to the MMCO's participation in the MA program.

Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.