On August 3, 2015, Judge D.J. Ramos of the Southern District of New York denied Healthfirst’s motion to dismiss the United States’ action under the False Claims Act (FCA) and the related state action. Healthfirst contended in its motion that the government failed to sufficiently plead the case. Notably, in denying this motion, the court […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released its State Fiscal Year 2015-2016 Work Plan. The Work Plan is a road map of where the OMIG intends to go in terms of its anti fraud, waste and abuse efforts with respect to the Medicaid program. The OMIG’s stated mission is […]
The New York State Office of the Medicaid Inspector General (“OMIG”) has released Compliance Guidance for use by DSRIP (Delivery System Reform Incentive Payment) Performing Provider System (“PPS”) Leads who are in the process of developing and implementing a compliance program. The document highlights special considerations PPS Leads should contemplate for each of the eight […]
This month, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) released its audit report for Ulster County’s 24-hour personal care services program.
In 2011, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) investigated New York City’s Medicaid claims for continuous 24-hour personal care services, an area that previous HHS OIG audits consistently identified as one vulnerable to fraud, waste, and abuse.
Medicaid Fraud Control Units (“MFCUs”) have a responsibility to combat Medicaid fraud and patient abuse and neglect. Toward that end, each MFCU maintains statistical data as to the number of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases. Each year, a summary […]
The New York State Office of the Medicaid Inspector General (OMIG) has released Compliance Guidance for use by Transportation providers. The routine identification of compliance risk areas, relating to the particular type of services being offered by Medicaid providers, is required for certain providers in accordance with the New York State Social Services Law Section […]
The New York State Office of the Medicaid Inspector General (OMIG) has released its final audit protocols for Dental providers in the Medicaid program. These protocols became effective October 1, 2014 and are the OMIG’s audit tool that they will use when conducting their audits of dental providers. The protocols contain 18 areas of potential […]
As 2014 comes to a close, the United States Department of Justice (“DOJ”) has many reasons to celebrate as it reflects on the year that was. In FY2014, the DOJ recovered $5.69 billion in settlements and judgments resulting from civil fraud and false claims cases, with $2.3 billion in health care fraud recoveries alone. This […]
It’s that time of year again when Medicaid providers who are required to have an effective Medicaid Compliance Plan have to so certify to the OMIG. The on-line certification can only be done during the month of December. 2014 Compliance Program Certification information and forms for the December 2014 certification period are now posted on […]