Tag Archives: Office of Medicaid Inspector General

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 were identified within the Third Party Liability Home Health Care Demonstration Project, which targeted dual-eligible populations who received home health care.

Notably, the audit that led to this recovery was conducted using a sampling technique, rather than an individual, case-by-case analysis of each claim submitted.  The audit indicated that in some cases, Medicaid was billed first for services rendered to the beneficiary and then Medicare was billed, rather than the other way around.

The OMIG’s press release in this matter may be viewed here: http://www.omig.ny.gov/latest-news/697-496-million

 

Caitlin Monjeau contributed this post.

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Filed under Medicaid, Medicare, NY Office of Medicaid Inspector General

Auditing the Auditors, Part II: New York State Senate Republicans Request Independent Audit of the OMIG

As a result of a recent Congressional report on New York State’s Medicaid program, the Legislative Gazette has reported that Senate Republican leader Dean Skelos and New York State Senate’s Republican Conference have called for an independent audit of the New York State Medicaid program. A Congressional panel had requested that federal auditors review New York State’s $54 billion Medicaid spending and fraud, waste and abuse oversight programs.

A previous post on this blog, available here, reported that the U.S. House of Representatives Committee on Oversight and Government Reform issued a report entitled “Billions of Federal Tax Dollars Misspent on New York’s Medicaid Program.”  Among its conclusions are that fraud, waste, abuse and mismanagement has permeated the New York State Medicaid program for decades; that New York must crack down on wealthy individuals posing as indigent patients, as well as on allegedly excessive salaries paid to health care executives; and that New York overcharged the federal government $15 billion on its developmentally disabled patient facilities and that the state must repay an appropriate amount of the funds.

The report also questioned the operations of the New York State Office of the Medicaid Inspector General (OMIG), which is tasked with investigating and auditing the misspending of taxpayer funds. Congressional officials said either the federal Centers for Medicare and Medicaid Services (CMS) or the Government Accounting Office (GAO) must send auditors to New York to review the OMIG and various Medicaid programs.

Senator Dean Skelos said that “An immediate, independent audit of the entire state Medicaid system is imperative” and also that “These are serious allegations against OMIG.”

Recently, current and past employees of the OMIG have publicly criticized the OMIG and alleged that the office is performing poorly and that its staff suffers from low morale.

The Legislative Gazette article is available here.

For more information, please contact the author, David R. Ross, who served as Acting 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 OMIG.

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud, NY Office of Medicaid Inspector General

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 to HRA Commissioner Robert Doar, that the recoveries were “disappointingly low” and also that he was “…particularly concerned . . . HRA’s backlogged audits are due to frequent inaccurate and missed audit findings.”

Deputy HRA Commissioner Connie Ress defended the agency’s audits, claiming that the State has been slow to respond to it. NYC, along with a limited number of counties in New York State, conduct their own Medicaid audits and investigations as part of the Office of the Medicaid Inspector General’s County Demonstration Project.

The New York Post article can be found here.

For more information, please contact the author, David R. Ross, who served as Acting 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).

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud

OMIG Releases Annual Report for Calendar Year 2011

Today, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2011 Annual Report.  We will post a detailed analysis in the coming days. In the meantime, the report may be accessed here.

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Filed under Fraud and Abuse, Medicaid, Medicaid Fraud, NY Office of Medicaid Inspector General