OMIG Annual Report Details 2013 Activities

The New York State Office of the Medicaid Inspector General (OMIG) has released its 2013 Annual Report, detailing the following record Medicaid enforcement efforts in 2013:  

• More than $2 billion in avoided costs to the Medicaid program through OMIG program initiatives and preventive measures;
• Record recoveries of $879 million in Medicaid overbillings in 2013 and more than $1.73 billion over the past three years; and
• More than $226 million in identified Medicaid overbillings through audit activities.

Among OMIG’s 2013 initiatives identified in the report are: (1) investigations and audits of social adult day care programs contracting with managed care plans; (2) a joint letter from OMIG and DOH to all nursing homes urging the proper use of antipsychotic medications for residents; (3) 50 nursing home capital audits and 25 base year audits completed, with identified overpayments of $7.3 million and $19.9 million, respectively; (4) audits of nursing home Minimum Data Set (MDS) assessments, with 496 MDS reviews conducted in 2013; and (5) expanded managed care plan audit activities primarily focused on enrollment and eligibility, including 13 managed long term care eligibility and care management audits.  

OMIG excluded 685 providers and issued 16 notices of termination during 2013. These individuals and entities are censured or excluded from the Medicaid program depending on the nature and severity of the offenses.  The exclusion list contains 5,099 Medicaid and non-Medicaid provider exclusions, and the list of terminations has 1,170 entries. These lists are updated daily (except holidays and weekends) and are available to the public on OMIG’s website.

Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866