MedicaidAdministrativeHigh impact
New State Requirements for Provider Compliance Programs
Healthfirst·NY·Provider Update
We identified it
Jun 20, 2026
Summary
New York State now requires all healthcare providers to establish and maintain formal compliance programs meeting 18 NYCRR Part 521 standards. Providers must certify annually by December 31st that they have implemented an effective compliance program, with Healthfirst reserving the right to audit compliance and terminate contracts for non-compliance.
Action Required
By December 31, 2024 and annually thereafter: All New York providers must complete compliance program certification using the OMIG web portal. Administrative staff must ensure practice has implemented a formal compliance program meeting 18 NYCRR Part 521 requirements (detailed at https://www.omig.ny.gov/media/80411/download?attachment). Failure to certify or maintain adequate compliance program may result in contract termination with Healthfirst.