Late last week, the New York State Department of Health discontinued Soundview’s participation in the state’s Medicaid program. Citing lack of a Medicaid Compliance Plan on the part of Soundview, the DOH has removed the home from Medicaid participation effective September 12th of this year. The Department acted upon recommendation by the Office of the Medical Inspector General, which noted lack of compliance with state Medicaid regulations and shortcomings within the home’s operations.
Soundview residents receiving Medicaid benefits will not be denied access to medical care. The DOH ruling does not immediately impact those residents receiving aid from Medicare or private insurance.
Title 18 Section 521.3(a) of the New York Administrative Code states that all providers “shall adopt and implement an effective compliance program.” Such compliance programs are applicable to billing, payments, and mandatory reporting, among other operational aspects of healthcare providers. Based on the findings of the OMIG, the Department of Health found this compliance lacking in the case of Soundview, and thus stripped it of its Medicaid eligibility.
Website Resource: New York State Department of Health