Every year the New York State Office of the Medicaid Inspector General (OMIG) publishes a work plan that outlines the agency’s focus in the coming year. As in previous years, the targets of agency’s audits and investigations this work plan cycle remain physicians, dentists, laboratories, transportation providers, pharmacies and DMEs, as well as hospitals and home and community health service providers. Below we discuss some of OMIG’s planned integrity activity. [...]
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Medicaid Audit UpdatesEvery year, the New Jersey Medicaid Fraud Division (MFD), the watchdog agency for New Jersey’s Medicaid program, releases a workplan which informs providers, suppliers and their advisers about the agency’s focus for the up-coming year. MFD’s 2012 workplan outlines a comprehensive audit and review agenda. We have summarized the agency’s audit criteria to help New Jersey Medicaid providers become aware of and stay prepared for scrutiny in 2012. [...] On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced an unprecedented partnership between private and public healthcare insurance organizations focused on fighting healthcare fraud. [...] In the workplan released earlier in the week, the New York State Office of the Medicaid Inspector General (OMIG), which is an independent agency within the Department of Health, renewed its commitment to fighting fraud, waste and abuse in the New York Medicaid Program. One of the nine business lines that the agency will focus on during the 2012-2013 fiscal year includes the following three providers: physicians, dentists and laboratories.
Continue reading » The New Jersey Medicaid and New Jersey FamilyCare programs insures more than one million New Jersey residents. Review responsibilities of the different units within the Medicaid Fraud Division, the State’s “watchdog” agency over these programs. [...] The Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and their contractors seeking to safeguard the Medicare Trustfund. Below is a brief description of some of the auditing contractors:
Continue reading » If a New York doctor accepts Medicaid and practices in New York that may be enough be included an audit program conducted through a project known as Payment Error Rate Measurement Program (PERM).
Continue reading » When a provider participates in the New York State Medicaid Program, a provider agrees to accept payment as payment in full for the provided services. The same applies to providers who accept Medicaid Managed Care or Family Health Plus (FHPlus) plans.
Continue reading » Many providers were disappointed to learn that on September 23, 2011, New York Governor Andrew Cuomo vetoed a bill that was previously passed without opposition by both houses of the New York State legislature (A.5686-A Gottfried and S.2184-A Little). According to the press release of one of the bill’s sponsors, “[t]he bill would set forth standards for the Office of the Medicaid Inspector General (OMIG) audit process in order to protect honest providers and the patients they serve.” The highlights of the bill are discussed here. In the last few years, many healthcare providers have come under increased scrutiny from federal and state investigative and auditing agencies. The recent USAToday article confirms that the federal government stepped up the prosecution of health care fraud. In fact, according to USAToday “[n]ew government statistics show federal health care fraud prosecutions in the first eight months of 2011 are on pace to rise 85% over last year due in large part to ramped-up enforcement efforts under the Obama administration.”
Continue reading » A bill introduced in the New York Senate on February 10, 2011, and which passed both of the New York’s State legislative houses in June (A.5686-A Gottfried and S.2184-A Little), is awaiting Gov. Cuomo’s approval. The bill will impact the power of the Office of the Medicaid Inspector General (OMIG) and will address some of the practices viewed as unjust by the provider community. Many providers believe that OMIG’s aggressive auditing approach has been unfair and see the office as having “strayed far from the goal of rooting out fraud and encouraging appropriate accountability.”
Continue reading » Nowadays State and Federal governments are focused on making healthcare fraud, waste and abuse their top priorities. In furtherance of this goal, the Centers for Medicare & Medicaid Services (“CMS”) announced recently that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud.
Continue reading » At a recent Health Care Fraud Prevention and Enforcement Action Team presentation given by the Office of Inspector General (OIG), the agency stressed the importance of documentation and identified the following seven common billing abuses performed by providers.
Continue reading » In order to meet the enhanced program integrity provision of the Affordable Care Act, signed by President Barack Obama in March 2010, as well as the New York False Claims Act signed by Governor David Paterson in August 2010, the Office of The Medicaid Inspector General (OMIG) is ramping up the number of investigations and audits of the State’s healthcare providers. Even before these laws were implemented, OMIG was under pressure to produce results.
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