Attention DSRIP Performing Provider System Leads: OMIG Highlights Special Considerations for Compliance Plans

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 […]

HHS Looks to Collect $12 Million from New York State for Unallowable Continuous 24-Hour Personal Care Services

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.

Seventh Circuit Decision Highlights Scope of Anti-Kickback Statute

This month’s article from the Albany County Bar Association Newsletter offers brief summary of the recent decision in U.S. v. Patel, in which a physician was found to have violated the federal Anti-Kickback statute for an improper referral scheme with a home health agency, even though he did not actively divert patients to other providers. The […]

New York State’s Medicaid Fraud Control Unit by the Numbers

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 […]

Attention Medicaid Transportation Providers: OMIG Releases Compliance Guidance for Corporate Compliance Programs

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 […]

Attention Medicaid Dental Providers: OMIG Audit Protocols Released

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 […]

US DOJ Sets New Record for Fraud and False Claims Recoveries in FY2014

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 […]

Medical Marijuana Draft Regulations Appear on DOH Website

The New York State Department of Health has posted draft regulations on the medical use of marijuana in New York.  We’ll have more on these regulations in coming days.  In the meantime, the interested should visit the DOH Medical Marijuana Website for the draft regulations, which run to 120 pages.