The Office of the Medicaid Inspector General (“OMIG”) has released its Work Plan for the next Fiscal Year, which encompasses April 1, 2018, through March 31, 2019. The stated mission of the OMIG, an independent entity created within the New York State Department of Health, is to detect and prevent fraudulent practices within the Medicaid system and recover funds deemed improperly paid to health care providers. Accordingly, health care providers in New York are encouraged to review the Work Plan as a guide towards steering clear of practices or services that OMIG may consider fraudulent.
OMIG continues to expect health care providers to “self-correct” and “self-report” potential fraud, waste and abuse. Providers are strongly encouraged to seek legal counsel if a potential issue is discovered prior to making any timely disclosure to the OMIG. Towards ensuring compliance, the OMIG also indicates it will:
- Maintain a dedicated telephone line and email address to field inquiries regarding potential issues: (518) 408-0401 and email@example.com;
- Enforce the obligations of health care providers to complete mandatory compliance certifications;
- Conduct compliance program reviews of health care providers; and
- Implement and enforce Corporate Integrity Agreements.
Identification of Fraud, Waste, and Abuse
The OMIG indicates that it will collaborate with federal and state investigative agencies, including the United States Department of Justice and New York State Attorney General’s office, in pursuing cases of medical fraud. Specifically, the OMIG will focus on health care providers involved in the:
- Prescription of opioids to combat the misuse, abuse, or diversion of drugs;
- Provision of health care through Home Health and Community-Based Care Services, including the Long-Term Home Health Care Program, Certified Home Health Agencies, and Person Care Services;
- Long-Term Care Services through resident care and nursing home audits; and
- Medicaid Managed Care program.
The OMIG has also said it will continue to audit Fee-for-Service providers, as well as the eligibility of health care providers to participate in the Medicaid EHR incentive program.
The OMIG has announced that it will continue to implement measures intended to detect what it deems to be fraud. These measures include mining the data it routinely obtains based on the patient encounter information provided by health care providers. Moreover, the OMIG indicates that it will continue to work with third-party entities, known as Recovery Audit Contractors, to audit and seek refunds from health care providers.
Health care providers should carefully review the OMIG Work Plan, which can be found on its website here. Furthermore, health care providers are strongly encouraged to seek the advice of attorneys who specialize in health care law in the event a potentially reportable issue is identified.
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