The New York State Office of the Medicaid Inspector General (“OMIG”) has released its annual Work Plan for fiscal year 2017-18. The annual Work Plan offers providers insight into OMIG’s areas of focus in the New York State Medicaid program for the upcoming year. As stated in the Work Plan, the OMIG’s overall mission “is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.” The OMIG is also charged in its enabling statute with maximizing the recovery of Medicaid overpayments.
As stated in the Executive Summary, New York State’s Medicaid program is the state’s largest payer of health care and long-term care. Over six million New Yorkers receive Medicaid-eligible services through a network of more than 80,000 health care providers and over 90 managed care plans. The total federal, state and local Medicaid spending for SFY 2018 is expected to be $65 billion.
The 2017-18 Work Plan is informed by the OMIG’s SFY 2018-2020 Strategic Plan, which focuses on three overarching goals: enhancing compliance; fighting fraud, waste, and abuse; and promoting innovative analytics to detect fraudulent or wasteful activities.
In furtherance of its goal to enhance compliance, among other things, the OMIG will continue to monitor annual certification performance obligations required of Medicaid providers under the Social Services Law, as well as False Claims Act requirements of the federal Deficit Reduction Act (DRA) of 2005 for certain providers, and closely monitor providers under corporate integrity agreements (CIA).
As part of its goal in fighting fraud, waste, and abuse, the OMIG plans to continue its efforts to identify and restrict recipients who abuse Medicaid benefits and will increase its oversight of MCO restriction plans to ensure compliance with the Managed Care Model Contract. The OMIG also seeks to continue to ensure the integrity of the Medicaid program by working to reduce drug misuse, prescription opioid abuse, and drug diversion. In addition, the OMIG’s Recipient Investigation Unit’s (RIU) Forged Prescription Project will continue to identify fraudulent prescriptions being billed to Medicaid.
This year’s Work Plan, like all those before it, also focuses on identifying and addressing fraud, waste, and abuse in the Medicaid program. As such, OMIG will be targeting areas in Home Health and Community-Based Care Services, Long Term Care Services, and Medicaid managed care. The OMIG also launched a project team approach to Medicaid managed care program integrity activities and has created teams with specific areas of focus.
In its promotion of innovative analytics, by using analytical tools and techniques, and possessing knowledge of Medicaid program rules to data mine Medicaid claims and identify improper claim conditions, the OMIG is able to identify potential recoveries of inappropriate Medicaid expenditures. As part of this goal, in SFY 2018, the OMIG will focus on partial hospitalization, an intensive outpatient treatment program licensed by OMH, designed to provide patients with profound or disabling mental conditions individualized, coordinated, comprehensive, and multidisciplinary treatment in an outpatient setting.
Mary Connolly, Esq. assisted in writing this blog post. For more information about Medicaid matters, contact David R. Ross, Esq., Shareholder, 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. He can be reached at (518) 462-5601 or via e-mail at firstname.lastname@example.org.