Program Integrity Budget Provisions Outlined 

The 2020-21 state budget includes a number of program integrity provisions that impact the substantive requirements for a compliance program and the potential financial consequences and penalties for failing to have an effective compliance program.

These provisions were recently summarized in a memo prepared by Hinman Straub, HCA’s public affairs firm.

Some prominent provisions include:

  • Every home care services worker, personal care aide, and personal assistant will be required to obtain an individual unique identifier from the state on or before a date to be determined by the commissioner of health in consultation with the state Office of the Medicaid Inspector General (OMIG).
  • Providers are required to have a compliance committee, in addition to the compliance officer, to oversee the compliance program.
  • Training must be provided to the compliance officer, as well as employees, senior management and governing body members.
  • Compliance training must be provided at orientation for new hires and at least annually.
  • The adoption and implementation of a provider compliance program is now considered “a condition of payment from the medical assistance program.” As a result of this change, OMIG has authority to recoup all Medicaid payments received by a provider during a period for which it determined the provider did not have an effective compliance program in place.
  • OMIG is authorized to impose a monetary penalty of $5,000 per month, up to twelve months, for the failure to adopt and implement a compliance program that meets statutory requirements. The penalty increases to $10,000 per month, for up to twelve months, if a penalty was previously imposed within the past five years.
  • OMIG is authorized to impose monetary penalties on any provider that fails to report and return an overpayment within 60 days of its identification.