OMH Medicaid Compliance Program

Overview

The Office of Mental Health’s (OMH) Medicaid Compliance Office is responsible for developing and overseeing a Medicaid Compliance Program for OMH staff and contractors that:

• decreases the likelihood of unlawful and unethical behavior at an early stage
• encourages employees to report potential problems
• allows for appropriate internal investigation and corrective action of instances involving fraudulent, abusive, and wasteful practices within OMH

If you have questions or concerns, you can reach the Medicaid Compliance Office by calling 518-549-5370 or emailing Compliance@omh.ny.gov.

Medicaid Compliance Program

OMH’s Medicaid Compliance Program satisfies all the mandatory elements required by NYS Social Service Law §363-d and regulations at 18 NYCRR Part 521.

Requirements include:

• implementing written policies, procedures, and standards of conduct
• designating a Compliance Officer and convening a Compliance Committee
• conducting appropriate training and education for all Affected Individuals
• maintaining open lines of communication allowing for appropriate reporting, including anonymous reporting of compliance issues
• enforcing disciplinary standards through written, well-publicized guidance
• creation and enforcement of a policy of non-intimidation and non-retaliation for good faith participation in the Compliance Program
• identifying compliance risk areas
• conducting internal monitoring and auditing
• annual Compliance Program review
• monthly review for excluded providers
• responding appropriately to detected violations and developing corrective actions
• ensuring compliance with all requirements of the Medicaid Program, state, and federal laws

More information is available in the Medicaid Compliance Program Policy.

OMH employees, contractors, and all other Affected Individuals have a duty to report suspected or known Medicaid compliance issues to their supervisor or the Medicaid Compliance Officer and are encouraged to assist in their resolution.

OMH will not take any adverse personnel action against an employee for reporting a Medicaid compliance issue. Any other type of retaliation or intimidation against individuals who participate in good faith is also prohibited.

Failure to comply with any provisions of this Compliance Program may result in disciplinary action.

Report a Medicaid Compliance Concern

Use any one of these contacts to report a Medicaid compliance concern.

Contact the OMH Medicaid Compliance Office:

• Email: Compliance@omh.ny.gov
• Telephone: 518-549-5370
• OMH Medicaid Compliance Reporting Form (can be anonymous)
• Mail:

  OMH Medicaid Compliance Officer
  NYS Office of Mental Health
  Capital District Psychiatric Center
  75 New Scotland Avenue, Lower Unit N
  Albany, NY 12208

Contact OMH Customer Relations:

• Telephone: 1 (800) 597-8481
  The Customer Relations Line is equipped with lnterpre-Talk, an on-demand telephonic interpreter service. It is available in real time, so language is not a barrier to reporting.
• Send a Message

Report the matter to the NYS Office of the Medicaid Inspector General (OMIG):

• Telephone: 1-877-87FRAUD (1-877-873-7283)
• Online Medicaid Fraud Allegation Form

Report the matter to the NYS Office of the Inspector General:

• Telephone: 1-800- DO-RIGHT (1-800-367-4448)
• Email: inspector.general@ig.ny.gov

Report the matter to the NYS Attorney General’s Medicaid Fraud Control Unit:

• Medicaid Fraud Control Unit Complaint Form

Guidance and Resources

• Medicaid Compliance Brochure
• Medicaid Compliance Program Policy
• OMIG Audit Protocols