The Trouble with RACs

It seems the United States House of Representatives has taken aim at Medicare Recovery Audit Contractors (“RACs”). The RACs are private, non-governmental entities that are authorized by the Medicare program to conduct audits of Medicare providers and suppliers. In December, 2013, the Office of Medicaid Hearings and Appeals (“OMHA”) sent a letter to providers with […]

Auditing the Auditors: OSC Audits the OMIG and Questions the Accuracy of OMIG’s Cost Saving Figures

The New York State Office of the State Controller (“OSC”) has released its audit of the New York State Office of the Medicaid Inspector General (“OMIG”) entitled “Accuracy of Reported Cost Savings.” The final report, issued July 11th, presented OSC’s findings regarding the accuracy of the OMIG’s reported cost savings for calendar years 2008 through […]

Attention OMH Continuing Day Treatment Providers: OIG Releases Audit of CDT Programs, Seeks Repayment of over $18 Million to Federal Medicaid Program

The United States Department of Health and Human Services Office of the Inspector General (“OIG”) conducted an audit of New York State’s nonhospital-based Continuing Day Treatment (“CDT”) program.   CDT services are clinic services administered by the New York State Office of Mental Health (“OMH”). OMH’s CDT program provides Medicaid recipients with treatment designed to […]

OMIG Highlights Errors in Home Health Payments

The New York State Office of the Medicaid Inspector General announced on October 30 that it has recovered the single largest monetary recovery in its history, a sum of $211 million.  The repayment stems from an investigation of payments made on behalf of dually-eligible individuals, who are eligible for both Medicaid and Medicare.  The overpayments […]

Your Tax Dollar At Work: Fighting Medicaid Fraud, Waste, and Abuse in NYC

The New York Post has reported that the New York City Human Resources Administration (“HRA”) spent $15.6 million on Medicaid audits of providers since 2006 and has managed to recover only $11 million in misspent Medicaid funds.  The paper also reported that Medicaid Inspector General James C. Cox wrote, in a February 15, 2013 letter […]

Major Victory for Saratoga County Maplewood Manor in Appeal of OMIG Audit

Last week, Maplewood Manor, a nursing home owned and operated by Saratoga County and represented by Jeffrey J. Sherrin of O’Connell & Aronowitz, earned a major victory in its appeal of an audit conducted by the New York State Office of the Medicaid Inspector General (“OMIG”).  In a Decision After Hearing dated January 16, 2013, […]

Analysis on GAO Report: $102 Million Spent on Auditing Fees to Identify Less Than $20 Million in Overpayments

The Federal Government Accountability Office (GAO) has determined that a program to fight fraud in the Medicaid health system for the poor has cost the federal taxpayers at least $102 million in auditing fees since 2008 while finding less than $20 million in overpayments. The Medicaid Integrity Group (MIG), established by CMS as part of […]