New York Medicaid: Compliance program requirement

The Office of the Medicaid Inspector General (OMIG) requires certain providers maintain a compliance program. OMIG also requires providers annually attest that they have met this requirement to all Medicaid plans they participate in. Providers who must meet this requirement are listed in Section 521.1 - General requirements and scope | New York Codes, Rules and Regulations (ny.gov).

Eligibility

To be eligible to receive medical assistance payments for care, services or supplies, or to be eligible to submit claims for care, services or supplies for or on behalf of another person, the following must adopt and implement effective compliance programs:

• Persons subject to the provisions of articles 28 or 36 of the public health law
• Persons subject to the provisions of articles 16 or 31 of the mental hygiene law
• Other persons, providers or affiliates who provide care, services or supplies under the medical assistance program or persons who submit claims for care, services or supplies for or on behalf of another person for which the medical assistance program is or should be reasonably expected by a provider to be a substantial portion of their business operations

Next steps

If you are a provider who falls into one of the identified categories, please complete the required certification form available online. Please email your completed attestation to UnitedHealthcare annually at uhc_provider_compliance@uhc.com.