Tag Archives: OMIG

UPDATE: OMIG Releases Revised Compliance Guidance to OASAS Providers

The Office of the Medicaid Inspector General (“OMIG”) has issued Revised Compliance Guidance for use by providers regulated by the New York State Office of Alcoholism and Substance Abuse Services (“OASAS”). 

The revision clarifies that the Compliance Guidance examples are taken from OMIG Audit Protocols for OASAS Chemical Dependence Programs and Services for dates of service prior to the date that the Ambulatory Patient Group (“APG”) regulations (14 NYCRR Part 822) went into effect.  Once OMIG audit protocols are developed for the APG reimbursement system, OMIG may update this compliance alert.

Check out our original post for more information about this Compliance Guidance.

The Revised OMIG Compliance Guidance for OASAS providers is available here.

Kathleen Evers wrote this post.  For more information, please contact David R. Ross, 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.  Prior to his service at the OMIG, David held several positions at the New York State Office of Alcoholism and Substance Abuse Services, including Acting General Counsel, Deputy Counsel, and Associate Counsel.  He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.

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Filed under NY Office of Medicaid Inspector General

Attention OASAS Providers: OMIG Releases Compliance Guidance for Inpatient Chemical Dependency Rehabilitation and Outpatient Chemical Dependency Services

The New York State Office of the Medicaid Inspector General (“OMIG”) has released Compliance Guidance for use by providers regulated by the New York State Office of Alcoholism and Substance Abuse Services (“OASAS”).

New York State Social Services Law Section 363-d and the implementing regulations at 18 NYCRR Part 521 require OMIG to routinely identify compliance risk areas relating to the particular type of services being offered by Medicaid providers.  The purpose of the OMIG’s Compliance Guidance is to offer examples of compliance risk areas that may be of particular concern to those providing Inpatient Chemical Dependence Rehabilitation and Outpatient Chemical Dependence services.  Many of the examples are taken from OMIG Audit Protocols for OASAS Chemical Dependence Programs and Services, which can be found on OMIG’s Web site at www.omig.ny.gov.

Update: The OMIG Compliance Guidance for OASAS providers has been revised, and the guidance we wrote about in this post is no longer available online.  Please see our post about the recent revision to this Guidance.

Kathleen Evers wrote this post.  For more information, please contact David R. Ross, 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.  Prior to his service at the OMIG, David held several positions at the New York State Office of Alcoholism and Substance Abuse Services, including Acting General Counsel, Deputy Counsel, and Associate Counsel.  He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.

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Filed under NY Office of Medicaid Inspector General

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 2012. Continue reading

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Filed under Medicaid, NY Office of Medicaid Inspector General

Attention OPWDD 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 providers regulated by the New York State Office of Persons for Developmental Disabilities (OPWDD).

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 363-d and implementing regulations at 18 NYCRR Part 521. The purpose of the OMIG’s Compliance Guidance is to give examples of compliance risk areas that may be of particular concern to those providing Day Habilitation, Day Treatment, Residential Habilitation, and Medicaid Service Coordination services. Many of these are taken from OMIG Audit Protocols for Office for People with Developmental Disabilities (OPWDD) programs and services which can be found on OMIG’s Web site at www.omig.ny.gov.

The OMIG Compliance Guidance for OPWDD providers is viewable here.

For more information, please contact the author, David R. Ross, 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 (OMIG). He can be reached at (518) 462-5601 or via e-mail at dross@oalaw.com.

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Filed under NY Office of Medicaid Inspector General

Office of the Medicaid Inspector General Releases 2014-2015 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG) has released its State Fiscal Year 2014-2015 Work Plan. You can find the press release at: http://www.omig.ny.gov/latest-news/764-2014-15-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 within the Medicaid program. The OMIG’s mission is one of “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 Work Plan intends to “fight fraud, improve integrity and quality, and save taxpayer dollars.”

According to the Work Plan, the OMIG has established nine “business line teams” that each consist of multiple OMIG personnel from various functional areas within the OMIG that work as a team. The goals of these specialized, multidisciplinary teams include improved efficiency, more thorough reviews and investigations, and reduced time to completion.

Broad areas of Medicaid service provision that the OMIG has established business line teams for include, but are not limited to, the following: home and community care services; hospital and outpatient services; managed care; medical services in an educational setting; mental health, chemical dependence and developmental disabilities services; pharmacy and durable medical equipment; physicans, dentists and laboratories; residential health care facilities; and transportation.  Each business line will face varying degrees of scrutiny by the OMIG during this state fiscal year. There is a discussion of each area in the Work Plan available at: http://omig.ny.gov/images/stories/work_plan/2014-15_work_plan.pdf

In addition to the Business Line Teams discussed above, the OMIG also conducts various activities that relate to Medicaid program integrity across multiple business lines. The OMIG is again emphasizing the requirement for Medicaid providers to have an effective compliance plan, and the OMIG will be reviewing compliance plans for effectiveness. Part of an effective compliance plan, and the most significant part as far as the government is concerned, is the ability of the provider to identify and return Medicaid overpayments that the provider has received. The 60 day “report, repay and explain” self-disclosure requirement imposed by the federal Affordable Care Act is also a game changer. The OMIG will continue to review providers who do not make periodic self disclosures or who have never made such disclosures.

The areas listed in the OMIG’s Work Plan that cross multiple business lines are as follows:

AIDS-Related Issues

Ambulatory Patient Groups

Collaborative Efforts with Law Enforcement/Medicare Fraud Strike Force

Collaborative Managed Care Surveys

Compliance Program General Guidance and Assistance

Compliance Program Reviews

Corporate Integrity Agreement Enforcement

County Demonstration Program

Enrollment and Reinstatement

Estate and Casualty Recovery

Fee-for-Service Third-Party Retroactive Recovery Projects

Kickbacks and Inducements

Location of Services Unknown to New York State Department of Health

Managed Care Third-Party Retroactive Recovery Projects

Medicaid Consumer Investigations

Medicaid Electronic Health Records Incentive Payment Program

Medicaid Integrity Contract Audits

Medicaid Recovery Audit Contractor

Medicare Coordination of Benefits with Provider-Submitted Claims

Patient Protection from Disqualified Providers

Payment Error Rate Measurement Project

Pre-Enrollment Review

Prepayment Insurance Verification

Prepayment Review

Prior Findings

Self-Disclosure Efforts

Third-Party Liability and Commercial Direct Billing

Undercover Operations

There will be a continued emphasis on excluding those providers who commit fraud and abuse. Those who commit “inappropriate and fraudulent acts” will face exclusion from the Medicaid program, then, by operation of law, exclusion from the Medicare program, and in essence become virtually unemployable by most health care providers who accept federal funds.

If you would like to discuss any of the areas identified in the OMIG’s Work Plan, or anything else related to the Medicaid program, please feel free to contact the author of this article, David R. Ross, Esq., who was formerly New York State’s Acting Medicaid Inspector General under Governors Pataki and Spitzer. Mr. Ross was also the Director of OMIG audits and investigations as well as the OMIG’s General Counsel. He can be contacted via e-mail at dross@oalaw.com or reached by telephone at (518) 462-5601.

 

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Filed under Fraud and Abuse, Health Care Reform, Medicaid, Medicaid Fraud, New York State Agencies, NY Office of Medicaid Inspector General

The OMIG At Work: A Year Of Record Recoveries?

The New York State Office of the Medicaid Inspector General (OMIG) has announced that it has recovered $851 million in Medicaid funds for 2013.  If accurate, this amount will have set a new record (the prior record is claimed to have been $468 million for 2012) for the OMIG in a state where over $53 billion is spent annually on Medicaid. According to the Daily News, more than one half of the $851 million in recoveries, $496 million, originated from a settled dispute with the federal government about whether Medicare (vs. Medicaid) should have been billed for certain home health services. If the $851 million figure is reduced by the amount of the federal settlement, the amount recovered by the OMIG becomes $355 million for 2013.

Governor Cuomo issued a press release on the OMIG recoveries. “With more than $851 million recovered from Medicaid abuses in 2013 alone – the most in the State’s history – New York is truly leading the nation in fighting fraud and protecting taxpayer dollars,” Governor Cuomo said. “Our focus on cleaning up the Medicaid program is showing record-breaking results, and OMIG’s efforts serve as a role model for other states to follow. Eliminating this kind of waste is vital to transforming New York’s healthcare system, and this year’s tremendous amount of recoveries shows that we are well on our way to building a healthier and fairer New York.”

“Fighting Medicaid fraud is a cornerstone of our efforts, and anyone who steals from Medicaid should know that we will find them. OMIG is proud of this record result,” said Medicaid Inspector General James C. Cox. “This is an extraordinary accomplishment, and an historical achievement. Through dedication and perseverance, our staff not only met but exceeded all expectations in recoveries for the year. Governor Cuomo’s support was crucial to our efforts.”

The OMIG’s 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 a high quality of patient care.”

The Daily News article can be found here: http://www.nydailynews.com/new-york/ny-recoups-851-million-medicaid-funds-article-1.1599885.  Governor Cuomo’s press release can be found here: http://www.governor.ny.gov/press/02032014-medicaid-recoveries.

For more information, please contact the author, David R. Ross, 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 (OMIG). You may call David at 518.462.5601 or e-mail him at dross@oalaw.com

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Filed under Fraud and Abuse, Health Care Reform, Home Health Agency, Long Term Care, Medicaid, New York State Agencies, NY Office of Medicaid Inspector General

OMIG Posts Assisted Living Program Audit Protocols

The New York State Office of the Medicaid Inspector General (OMIG) has released its final audit protocols for Assisted Living Programs (ALPs). These protocols became effective November 22, 2013 and are the OMIG’s audit tool that they will use when conducting their audits of ALPs.  The protocols contain 22 areas of potential disallowances based upon various documentation requirements and timelines.

The protocols explain what will constitute an error to the OMIG and lead to the OMIG attempting to recoup money previously paid for Medicaid claims.  These protocols provide the best source of information as to what the OMIG will be looking for during an ALP audit, as well as what criteria ALP providers should be auditing themselves against. Click here to view the protocols. 

This post was written by David R. Ross, Shareholder of O’Connell and Aronowitz. Mr. Ross presented, along with Medicaid Inspector General James Cox, on OMIG ALP audits at the NYSHFA/NYSCAL Fall Conference last year in Troy, New York.

Mr. Ross served as General Counsel and Director of Audits and Investigations at the OMIG and was also the Acting Medicaid Inspector General under Governors Pataki and Spitzer. Please contact Mr. Ross for more information at dross@oalaw.com

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Filed under Long Term Care, Medicaid, New York State Agencies, NY 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

Jason Helgerson Makes MLTC Encounter Data a Priority

At a Managed Care Policy Meeting held last week with managed care plans, New York’s Medicaid Director, Jason Helgerson, spoke about the importance for plans to submit timely and accurate encounter data.  He noted that managed long term care plan submissions are particularly late.  He indicated that if the lack of reporting continues there is the possibility that Statements of Deficiencies (which can result in halting enrollments) will be issued and that the Department of Health will consider referrals to the OMIG for investigation and audit.  The plans responded by explaining that the challenge, in part, is that they are not receiving the required information from the providers (home care, nursing facilities, adult day health care, etc).  Continue reading

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Filed under Managed Long Term Care, Medicaid

Auditing the Auditors: OSC vs. OMIG

The Office of the New York State Comptroller (OSC) has just announced that it will be conducting an audit of the New York State Office of the Medicaid Inspector General (OMIG).   The audit, which is scheduled to be commenced June, is said to have been sparked by a congressional report (entitled “Billions of Federal Tax Dollars Wasted Annually by New York’s Medicaid Program”), newspaper articles, the recommendation of New York State Senate Republicans, and criticism by current and former employees of the OMIG alleging that the office has not been effective at pursuing Medicaid fraud, waste and abuse.

The OSC audit seeks to review performance results and outcomes at the OMIG. It is not known what metrics will be employed by the OSC in conducting its audit of the OMIG, which oversees the largest statewide expenditure of Medicaid funds in the entire country.

The Albany Times Union reported that Mark Johnson, a spokesman for the OSC, stated “New York’s Medicaid program is the largest in the country, and the widespread abuse found by various agencies over the years has been well-documented.” He also said that the OMIG “is the principal overseer of the program, conducting thousands of investigations a year and finding hundreds of millions of dollars in abuse. Given the enormity of the program, and recent cutbacks ordered by the federal government, the comptroller believes a thorough look at OMIG and its practices is warranted.”

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, Health Care Reform, Medicaid, Medicaid Fraud, NY Office of Medicaid Inspector General