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Medicaid Providers, Beware: OMIG Places Provider Compliance Programs Under Review

The NYS Office of the Medicaid Inspector General ("OMIG") has dramatically increased enforcement activity in connection with Medicaid provider compliance programs: OMIG is notifying providers that their compliance programs are being placed under review. Providers should take immediate action to avoid the prospect of serious sanctions, including but not limited to revocation of Medicaid Program enrollment.

Under Medicaid Program rules, providers submitting "significant" amounts of Medicaid claims must annually certify that they developed and implemented a Medicaid compliance program. This requirement also applies to entities submitting claims on behalf of providers. "Significant" is measured proportionally to the provider's business. Previously, OMIG enforcement activity was generally limited to notifying providers who failed to annually certify.

Providers are now receiving notice that OMIG is reviewing their Medicaid compliance programs. OMIG's notice contains detailed demands for documents demonstrating that the provider has satisfied the compliance program requirements set forth in Medicaid Program rules. Medicaid providers and other covered entities are therefore advised to immediately take the following protective actions:

  • If you do not have compliance program in place, immediately begin developing and implementing a program;
  • If you have a program in place, undertake a thorough review to ascertain that the program meets all Medicaid Program requirements and has been properly implemented;
  • If you receive a notice of review from OMIG, ensure that your response does not expose you to any potential sanctions;
  • If you require expert legal guidance with respect to an OMIG review or implementation of a Medicaid compliance program, please do not hesitate to call one of the experienced healthcare attorneys at (212) 668-0200 or email the firm at
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Friday, December 01, 2023