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 audits of the State’s healthcare providers. Even before these laws were implemented, OMIG was under pressure to produce results.

According to Medicaid Work Plan (SFY 2009-2010), in 2006, New York State signed an agreement with the United States Department of Health and Human Services to repay health care modernization grants given to New York with the state’s recovery of more than $1.6 billion in fraud and abuse payments between October 1 2007 and September 30, 2011.

Known as F-SHRP (for Federal-State Health Reform Partnership), this agreement contains strict requirements for the state to meet in terms of actual recoveries.  What this means is that New York State has aggressive goals of recovering the following amounts:

$215 million in 2008
$322 million in 2009
$429 million in 2010
$644 million in 2011

Even OMIG has openly admitted that these goals, especially for FY 2011, are “ambitious and difficult to achieve.”  Nonetheless, according to New York State Dental Association and others, it is believed that OMIG is resorting to technical claims error made by participating providers to demand refund.

If you are contacted by OMIG, consult a knowledgeable attorney who would assist you in handling the matter.