2025                      5574

Non-Instructional/Business Operations

SUBJECT:    MEDICAID COMPLIANCE PROGRAM POLICY

The District will comply with New York State and federal laws and regulations related to the District’s participation as a provider of care, services, or supplies under the Medicaid program.

The District has further established and implemented a Medicaid Compliance Program designed to detect and prevent fraud, waste, and abuse, and to ensure compliance with all applicable laws and regulations..

As required by the New York State Office of the Medicaid Inspector General (hereinafter referred to as the OMIG), the District’s Medicaid Compliance Program is comprised of the following core elements:

1. Written policies and procedures that describe compliance expectations as embodied in a code of ethics applicable to all District personnel, including Board members. These compliance expectations or standards of conduct include provisions designed to: implement the operation of the Medicaid Compliance Programs; provide guidance to employees and others on dealing with potential compliance issues; identify how to communicate compliance issues to appropriate personnel; reporting issues; and describe how issues are investigated and resolved;
2. A designated employee who will be responsible for the day-to-day operation of the Medicaid Compliance Program. This employee’s job duties may be exclusively related to Medicaid compliance issues or may be combined with other duties, provided that the Medicaid compliance portions of the employee’s duties are satisfactorily fulfilled. The designated employee will report directly to the Superintendent or designee and also periodically report directly to the Board on the District’s Medicaid Compliance Program activities. The Board will appoint the Compliance Officer annually at its organizational
   meeting. The Compliance Officer shall oversee the program, promptly investigate reports of noncompliance, and report the findings as appropriate to the Medicaid Inspector General, the Superintendent, and the Board of Education;
3. The Director of Special Programs will remain informed of services covered by Medicaid to ensure the District submits complaint claims. Staff, contractors, and agents must avoid filing false claims, which would subject the District to civil and criminal liability.
4. The district will ensure it does not hire or contract with providers excluded from Medicare and Medicaid. The Director of Special Programs will check provider credentials before engagement. Employees must immediately notify the Compliance Officer and Human Resources if their license has been suspended, revoked or lapsed, or if they have been excluded from the Medicaid program.
5. Upon receiving notice of an employee’s or provider’s exclusion, the District will take remedial steps as soon as possible. Contracts with outside providers will include provisions addressing this requirement.
6. The Director of Special Programs will check the list of excluded providers monthly to determine if any employees or contractors providing Medicaid-covered services have been added or reinstated. Any exclusions will be immediately reported to the Superintendent, who will initiate remedial action.
7. A Compliance Committee consisting of senior managers will assist the Compliance Officer and meet at least quarterly to review compliance activities, risk areas, and program improvements.
8. Annual and periodic training and education including reporting obligations, whistleblower protections, and procedures for addressing compliance issues of all affected District employees and other persons associated with the District’s Medicaid Compliance Program, including, but not limited to, members of the District’s Board. This training will occur periodically and be made a part of any required training or orientation for new employees, Board members, volunteers, and/or others on dealing with the District’s Medicaid Compliance Program. Documentation of all training will be maintained.
9. Communication lines and processes directed to the District’s designated employee who will be responsible for the day-to-day operation of the Medicaid Compliance Program. These communication lines and processes will be accessible to all District employees, Board members, volunteers, and others associated with the District’s Medicaid Compliance Program. The communication lines and processes are designed to allow employees to report compliance issues, including the anonymous and confidential good faith reporting of any practice or procedure related to Medicaid reimbursement of school or preschool supportive health services, that an employee believes is inappropriate. The District will inform employees of this mechanism consistent with guidance from the new York State Education Department and Department of Health.

   Disciplinary procedures that encourage good faith and fair dealing in the District’s Medicaid Compliance Program by all affected individuals. These disciplinary procedures include procedures that articulate expectations for reporting and assisting with the resolution of compliance issues and also provide sanctions for the failure to report suspected problems and participating (either actively or passively) in non-compliant behavior or retaliation against individuals who report in good faith. Failure to comply with this policy or the reporting requirements may result in disciplinary action, up to and including termination, in accordance with law and collective bargaining agreements;

10. A system for the routine identification of Medicaid compliance risk areas in the District’s Medicaid Compliance Program. Self-evaluation of such risk areas may be accomplished by, but not necessarily limited to, internal audits and external audits, as appropriate. Medicaid claims will be included as part of the District’s annual risk assessment and reviewed at least annually or as directed by the Audit Committee or Board of Education. When weaknesses are identified, the Superintendent will implement corrective action;
11. A system for responding to, investigating, correcting, and reporting compliance issues as they are raised, including the development of procedures and systems to reduce the potential for recurrence, identifying and reporting compliance issues to the OMIG and refunding overpayments; The Compliance Officer is responsible for ensuring that the system for receiving reports and responding appropriately is implemented; 
12. The District will actively monitor employees and contractors to ensure that no
    individuals or entities excluded from Medicaid participation are providing services; and
13. A policy of non-intimidation and non-retaliation against any person for the good faith participation in any aspect of the administration of the District’s Medicaid Compliance Program including, but not limited to, the reporting of potential issues, assisting as a witness with any investigation, evaluation, audit, remedial actions or reporting to appropriate officials.

• Social Services Law §§§145-b (False Statements); 145-c (Sanctions); 363-d (Provider Compliance Program)
• 18 NYCRR Part 521 et seq. ( Provider Compliance Program regulations)
• Labor Law §§ 740 and 741 (Prohibits Retaliation)

NOTE:      Refer also to Policies

• False Claims Act, 31 U.S.C. §§3729, et seq.
• State Finance Law §§187 et seq. (New York False Claims Act)
• #5570 — Financial Accountability
• #5571 — Allegations of Fraud
• #5572 — Audit Committee
• #5573 — Internal Audit Function
• #6110 — Code of Ethics for Board Members and All District Personnel
• District Medicaid Compliance Program

Adopted:  8/24/11

Revised:  9/22/20; 12/16/25