Tag Archives: Withhold

OMIG Adopts Regulations Concerning Withholding of Medicaid Payments When Fraud Is Alleged

In accordance with federal law, the OMIG has finalized proposed regulatory changes to conform New York State law to federal law regarding the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” This requirement is imposed on States that participate in the Medicaid program as part of the the Affordable Care Act (see 42 CFR § 455.23). The regulations that have been modified are 18 NYCRR 518.7 and 18 NYCRR 518.9.  18 NYCRR Part 518.9 has incorporated the above federal regulation by reference in its entirety.

There was public comment on the proposed regulatory changes. However, the OMIG did not make any changes as a result of the public comment. A minor technical correction was made in 18 NYCRR § 518.7(a)(1) in that the term “law enforcement agency” was deleted and replaced with the term “law enforcement organization.” Continue reading

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Filed under Health Care Reform, Medicaid, Medicaid Fraud, Medicare Fraud, NY Office of Medicaid Inspector General, PPACA