Opening to liability by certifying compliance plan?

November 15, 2012

Question:

Jennifer,

Thank you for sending Tuesday's newsletter regarding Medicaid's compliance plan and compliance certification requirement.   I believe that I fit the parameters of a Required Provider because while I do not directly receive $500,000 of Medicaid money, I do receive monies from Medicaid HMOs and I order services payable to other providers by Medicaid and Medicaid HMOs.  My question is, if I have qualified in previous years since 2009, am I opening myself up to liability by just now adopting and certifying I have a plan in place?

Thanks,
Dr. C

Answer:

Dr. C, you are not the first to inquire about this.  The answer is, Medicaid already knows if you are not complying based on the Office of Medicaid Inspector General's ability to decipher who is required to have a plan and who has not certified.  Understanding the preceeding sentence may assist in your review and lead you to the conclusion that right now, without a plan, and without certifying, you absolutely have potential exposure.  By adopting a plan and certifying, you are removing your practice from the "no plan" list that OMIG currently is working through.  Importantly, I have not seen any fines imposed or ramifications for "late" filing.  I have just begun to see ramifications for those practitioners reviewed that do not have plans in place.  While OMIG could review and potentially fine for time a Required Provider did not have a plan in place and/or certified, those reviews have not been happening on a reportable basis, as far as I am aware. 

Bottom line, if  you practice depends on Medicaid enough that you qualify as a Required Provider, do not risk review, potential exclusion from Medicaid, sanctions, etc.  Take the time to comply prior to coming under scrutiny.