A compliance program establishes a culture that promotes integrity and ethical behavior. It safeguards public and private funds by helping to control fraud waste and abuse and provides a method to detect and report, correct and prevent noncompliance.
NYS Social Services Law (SSL) requires the following providers to implement a mandatory compliance program that meets the requirements of the SSL and to annually certify that such requirements have been met.
- Providers licensed under Articles 28 or 36 of the Public Health Law; or
- Providers licensed under Articles 16 or 31 of the Mental Hygiene Law; or
- Providers, licensed or not, that have claimed or received, or expects to claim or receive, more than $500,000 in Medicaid reimbursement in any consecutive twelve-month period.
Some PPS Partners that are not currently required to have compliance programs under NYS law may become required to do so, by virtue of receipt of DSRIP payments that result in meeting the $500,000 threshold.
If you are not currently required to maintain your own compliance program, you must comply with the FLPPS compliance program. As a FLPPS Partner, you are required to:
- Participate in meeting the applicable metrics of the DSRIP program
- Implement training and education provided by FLPPS
- Develop or maintain a compliance program where required under NYS law
- Observe contractual and other compliance requirements as required by FLPPS, state law, regulation and policy.
If you remain unsure as to whether or not you are required to have a compliance program, visit the OMIG Compliance Program Decision Tree for assistance.