New York

Thursday, August 27, 2009

ALBANY, N.Y. – New York in October will become the first state in the country to require that HME providers have compliance programs in place.

The state put providers on notice in July that, if they bill Medicaid for $500,000 or more annually, they had 90 days to comply with the requirement.

“I welcome it to the extent that it helps to root out fraud and abuse,” said Greg Lopresti, COO of Upstate Homecare in Clinton, N.Y., who has had a compliance program in place for years. “Because fraud gives everyone a black eye.”

The state hopes the requirement will not only root out fraud and abuse but also prevent billing and payment mistakes.

The New York Medical Equipment Providers Association (NYMEP) estimates that 20% of its members will have to comply with the requirement. To help them, the association offers a manual and in-person training.

“We’ve been letting providers know that this was coming, so, hopefully, it wasn’t too much of a surprise,” said Carol Napierski, NYMEP’s executive director.

Upstate Homecare’s compliance program includes training for new hires, self-audits (to identify possible cases of improper billing) and marketing-specific policies and procedures.

“We review these annually,” Lopresti said.

The requirement is the brainchild of the state’s Office of Medicaid Inspector General. The fairly new office is to Medicaid what the Office of Inspector General (OIG) is to the Department of Health and Human Services.

“They’ve been very aggressive with audits,” Napierski said.

Providers will have to “certify” every December that they have a compliance program in place.

The office details the minimum components of a compliance program on its Web site, The components include training and education, and disciplinary policies.