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Preventing Medicaid Fraud, Waste and Abuse

In its effort to support and assist individuals with disabilities, Arc of Seneca Cayuga has as a priority, to maintain fiscal stability along with provision of quality services. Arc of Seneca Cayuga is committed to provide quality services and conduct business in a manner that promotes compliance with all laws and regulations that govern the services we provide. In order to do this, we need to maintain a culture of transparency so that there is openness, excellent communication and accountability to and with all stakeholders.

In June 2009 the New York State legislature passed regulation which mandates that all providers of Medicaid funded programs develop a corporate compliance plan. Our agency established a compliance plan in 2003 and continues to review and revise the content, as appropriate. It is a compilation of policies and practices aimed at demonstrating that we take our charge seriously.

Our plan consists of eight elements:

  1. Corporate Compliance Policy
    • Will follow laws, regulations, policies
    • Operate with integrity
    • Everyone is responsible to report issues
  2. Compliance Program Oversight
    • Compliance committee meets on regular basis
    • Compliance officer responsible for program
  3. Education and Training
    • Part of new staff orientation/board orientation
    • Added to the Coaching Plan
    • Annual refreshers
    • Ongoing postings on staff web site
  4. Effective Confidential Communications
    • Use supervisory chain
    • Contact Compliance Officer
    • Confidential Help Line
    • E-mail - compliance@arcsencay.org
  5. Enforcement of Compliance Standards
    • Reported issues are investigated
    • Recommendations are made
    • Progressive Guidance Policy is followed
  6. Auditing and Monitoring of Compliance Activities
    • Pre and Post billing audits are completed
    • Quarterly review of the Compliance Plan is completed
    • Annual Risk Assessment completed
  7. Detection and Response
    • Issues discovered are investigated thoroughly
    • Systems are revised
    • Policies are reviewed and modified as appropriate
  8. Whistle Blower Protection (non-retaliation for reporters)
    • Reporters are protected from reprisal

Our Compliance Program exists to provide on-going systematic checks of our processes and assure that we are meeting the standards set by any and all oversight agencies. We believe that we have a responsibility to operate with integrity and that our actions are based on the mission of the agency. Our Board of Directors has open communication with our compliance officer and receives regular reports on the compliance activities of the agency.

Within our compliance program we conduct internal audits of documentation, provide on-going training for staff, measure our compliance to standards based on identified areas of risk as well as regulatory guidance.

We welcome contacts from stakeholders. We pledge to act in an ethical manner and take all complaints seriously. If you are aware of situations that may not be in keeping with our promise, we want to hear from you.

Examples of issues that may need further review:

  • Services not being provided as scheduled
  • Lack of communication between program and stakeholder or family
  • Frequent cancellation of services
  • No accounting of monies used during service delivery
  • Lack of quality of service
  • Being billed for services not provided
  • Being billed for services different than those provided

Contact can be made through any of the following means:

  • E-mail to: compliance@arcsencay.org
  • Confidential Help Line: (315) 856-8060
  • Compliance Officer: (315) 612-0136
  • In writing to: Compliance Officer, 1521 Clark St Road, Auburn, NY 13021
  • In writing to: Compliance Officer, 1083 Waterloo-Geneva Road, Waterloo, NY 13165

A copy of our compliance plan is available upon request.