NY’s OMIG Finds Basic Compliance Program Gaps

The Bureau of Compliance (BOC) within the New York State Office of the Medicaid Inspector General (OMIG) recently performed an assessment of providers’ compliance programs. The results indicate that providers sometimes fail in relatively less complicated and readily addressable ways.

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Providers Beware: Medicare Proposes Harsh New Screening Requirements

The Centers for Medicare & Medicaid Services (CMS) has once again proposed new rules which would enhance the screening requirements for providers and suppliers. The rule proposals would ratchet up the scrutiny on provider enrollments and toughen suspension and revocation penalties.

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New York OMIG’s Activities By The Numbers

New York Office of the Medicaid Inspector General’s (OMIG) 2013 annual report provides an important insight into the agency’s activities, recoveries and where it plans to focus its resources in the upcoming year.

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OMIG’s 2014-2015 Workplan

The New York State’s Office of the Medicaid Inspector General (OMIG) has released its program of activities for the current fiscal year. As in previous years, the agency’s audit and investigation function remain strong.

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NY Pharmacy Denied Medicaid Enrollment and Investigated

In August, the New York State Inspector General (OMIG) denied enrollment to a pharmacy after an on-site inspection revealed several deficiencies. An apparent egregious case of non-compliance serves as a vivid reminder of why providers must comply with their professional requirements as well as why they must observe NYS Medicaid rules and regulations at all times.

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New York OMIG’s Focus In 2013-2014

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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New York Medicaid Revises The Dental Manual

Recently the New York. State Medicaid Program published an updated version of the Dental Manual as well as the fee schedule. We highlight some of those changes below and encourage all dental providers to analyze the revised documents.

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Pharmacies and DMEs Under Scrutiny By OMIG

The New York State’s Office of the Medicaid Inspector General (OMIG) recently released the agency’s 2012-2013 workplan. The agency’s focus remains firmly on fighting fraud, waste and abuse, compliance and self-disclosure, and provider education. We look closer at how the OMIG plan impacts pharmacy and durable medical equipment (DME) businesses.

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Latest OMIG Plan Outlines New Areas for Medicaid Audits

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

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Documentation Requirements for New York Medicaid Transportation Providers

The New York Medicaid Program pays costs of all emergency ambulance and medically necessary non-emergency transportation, as well as the necessary transportation expenses for Medicaid enrollees who must travel an extraordinary distance to receive medical care. The New York Medicaid Program will only reimburse transportation providers if specific records verifying an occurrence of a trip are maintained for each leg of the trip.

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New York State Medicaid Included In The PERM Project

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).

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New York Medicaid Program Prohibits Billing Beneficiaries

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.

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New York’s Medicaid Provider Compliance Program

The New York State Social Service Law and its implementing regulations require that Medicaid providers develop, adopt and implement effective compliance programs aimed at detecting fraud, waste, and abuse in the Medicaid program. These programs are mandatory for those providers operating under Article 28 or 36 of the Public Health Law and Articles 16 or

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Governor Cuomo Vetoes OMIG Reform Bill

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

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OMIG’s Powers To Be Limited By Pending New York Law

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

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CMS and OMIG Team Up To Measure Improper Payments

The Centers for Medicare & Medicaid Services (CMS) and the New York State Office of the Mediciad Inspector General (OMIG) have teamed up to analyze and measure whether improper payments in the Medicaid and State Child Health Insurance programs have been made to healthcare providers. Under the Payment Error Rate Measurement (PERM) program, which was

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OMIG Identifies Core Requirements For All Providers

Many New York State healthcare providers have recently felt the heavy hand of the state enforcement agency as the Office of Medicaid Inspector General (OMIG) seeks to recoup payments paid out to providers in an effort to eliminate fraud, waste and abuse in the healthcare industry. At a recent presentation given by OMIG, the agency

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New York State Medicaid Investigators Focusing On Dentists

There is an increased focus on the dental community from the New York State Office of Medicaid Inspector General (OMIG). At an increasing rate, OMIG is conducting audits of dentists and dental specialists, putting additional burden on providers already taxed with other statutory, regulatory and malpractice concerns.

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NYS OMIG Steps Us Its Recovery Efforts: Provider Alert

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

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