The United States Department of Health and Human Services Office of Inspector General (“OIG”) issued a short Fraud Alert last week focusing on the anti-kickback implications of certain compensation paid to medical directors. OIG noted that it had recently settled with a dozen physicians who had entered into medical director positions of various health care […]
The New York State Medicaid program is projected to have a $62 billion-dollar price tag in State Fiscal Year 2016, with $22.4 billion paid out by the State, as explained by the New York State Office of the Comptroller (“OSC”) in its April 2015 report entitled Ensuring Integrity in New York State Medicaid. As Medicaid […]
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 […]
This month’s article from the Albany County Bar Association Newsletter discusses the New York Attorney General’s recent settlement with Excellus, a Rochester-based health insurer, which resulted from an investigation into complaints from consumers that Excellus was improperly denying claims for mental health and substance abuse treatment. The article also includes a brief overview of New […]
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 […]