Compliance Officers Medicaid Overpayment 
Healthcare Law Blog
FEBRUARY 3, 2023
New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]
Health Law Advisor
AUGUST 25, 2023
It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. Part 521, make several important changes that will affect all Medicaid Providers’ compliance programs throughout New York State. New York Social Services Law § 363-d.
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YouCompli
SEPTEMBER 13, 2023
Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. For staff, compliance officers should support annual online FWA compliance training.
Compliancy Group
FEBRUARY 29, 2024
A Corporate Integrity Agreement is typically part of the civil settlement, and it prevents the violating entity from being added to HHS’s OIG Exclusion List , including organizations excluded from valuable programs like Medicare or Medicaid. IROs must be external to the participating organization and act with objectivity.
C&M Health Law
DECEMBER 18, 2023
Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)
Compliancy Group
FEBRUARY 7, 2024
This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.
AIHC
FEBRUARY 17, 2025
There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. Could it result in the cobra effect (explained further below).
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