NEONCOG's Mission

Provider Compliance Reviews

NEON conducts provider compliance reviews, on behalf of County Boards, of Adult Foster and Adult Family Living Providers, Independent and Agency Providers, and Non-Medical Transportation Providers. In order to ensure consistency, a standardized review process is used.

TYPES OF PROVIDER COMPLIANCE REVIEWS

Compliance Review – is a regularly scheduled review of a provider conducted prior to the end of the provider’s term license, accreditation term or at least once every 3 years for non-licensed waiver settings. The review is conducted utilizing the same review tool.

Special Compliance Review – is an unscheduled review, which occurs due to identified concerns such as complaints, Major Unusual Incidents or adverse outcomes identified by other entities such as the Ohio Department of Health (ODH) or the Ohio Department of Medicaid (ODM).

New to the System Review – is a compliance review that occurs within one year of a new waiver provider’s initial submission of waiver billing.

Plan of Compliance Verification – a follow-up, performed either on-site or as a desk review to ensure that the provider has implemented the Plan of Compliance submitted in response to a compliance review.

MUI/UI Documentation Verification Forms
Monthly UI Log Form
Semi Annual/Annual Review Form

ADVERSE OUTCOMES

Medicaid Fraud

The Ohio Department of Developmental Disabilities is committed to identifying and eliminating fraud. We view it as our collective responsibility to safeguard the limited resources available to Ohio Medicaid recipients. Providers are responsible for ensuring that Medicaid billings are accurate and that they are only billing for services for which they are authorized through the Individual Service Plan (ISP) and have provided. The County Boards and Councils of Government (COGs) provide local oversight and monitoring to ensure services are provided in accordance with the plan. Additional oversight is provided by the Department. The Department receives referral information regarding possible fraudulent activity and presents it to the Office of the Attorney General through bi-weekly Medicaid Fraud Control Unit Meetings.

Suspension, Revocation and Abeyance

The Department of Developmental Disabilities is committed to educating providers of the standards that must be followed and assisting them in maintaining compliance with rules through technical assistance and support. However, in some cases when good cause exists, the Department may initiate sanctions against a provider. Suspension of new services or revocation proceedings of a provider’s certification(s) or license(s) may be initiated if the Department finds one or more of the following:

  • Substantial violation(s) of applicable requirements when violation(s) present a risk to an individual's health and welfare
  • A pattern of non-compliance with either plans of compliance that have been accepted by the county board or those plans of compliance that the department has approved in accordance with this rule
  • A pattern of continuing non-compliance with applicable requirements
  • A licensed provider has had their license revoked by the licensing authority
  • Other good cause, including misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or other conduct the director determines is injurious to individuals being served Placement on the Abuser Registry
  • Conviction of Medicaid Fraud