The New York State Office of the Medicaid Inspector General (OMIG) has released its 2013 Annual Report (“Report”). The OMIG announced that it has recovered a record $879 million in Medicaid overbillings for 2013. More than $226 million of Medicaid overbillings were identified through audit activities. According to the Report, over the last three years, the OMIG recovered $1.73 billion in Medicaid overbillings, a 34 percent increase over the prior three-year period.
With respect to the $226 million in audit activities, $104 million was from fee for service audits, $47 million was from managed care audits, $7.2 million from the County Demonstration Project, and over $7 million from data mining activities. Over $16 million was self disclosed by providers.
$6.7 million was recovered by OMIG investigations in collaboration with several law enforcement partners. This is the highest total in five years.
The Report also claims over $2 billion in costs were avoided due to OMIG program initiatives and preventive measures. These measures included pre-payment reviews and monitoring of corporate integrity agreements. The savings from these activities is estimated by the OMIG to exceed $7 billion over three years, an almost $2 billion increase over the previous three years.
According to the report, and pursuant to the Affordable Care Act, “credible allegations of fraud” can lead to withholding of providers’ Medicaid payments. OMIG suspended $46 million in potentially inappropriate payments in conjunction with the Medicaid Fraud Control Unit of the New York State Attorney General’s Office.
More than 700 providers were excluded or terminated from the Medicaid program. As a result, these providers can no longer work in Medicaid-funded positions in health care or submit claims to the Medicaid program.
Additionally, OMIG referred 164 providers to the Medicaid Fraud Control Unit for potential criminal prosecution.
“Ensuring the integrity of the state’s Medicaid program is an essential component of Governor Cuomo’s ongoing, successful initiative to enhance the quality of care in the state’s health care delivery system while continuing to reduce costs,” Medicaid Inspector General James C. Cox said. “These record-setting recoveries and billions in cost savings play a major role in protecting the integrity of the state’s Medicaid program and ensuring New Yorkers have access to high-quality services.”
The Report can be found here: http://www.omig.ny.gov/images/stories/annual_report/2013_annual_report.pdf.
For more information, please contact the author, David R. Ross, who served as Acting New York State Medicaid Inspector General under governors Pataki and Spitzer, as well as General Counsel, Deputy Medicaid Inspector General, and Director of Audits and Investigations for the Office of the Medicaid Inspector General (OMIG).