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LeadingAge NY Strongly Objects to OMIG Nursing Home Audits

LeadingAge NY has filed written objections with the New York State Office of the Medicaid Inspector General (OMIG) to a series of desk audits of nursing homes seeking to disallow certain services, such as laboratory and radiology (i.e., x-ray) services, in their entirety from those providers’ Medicaid rates. As justification, the letter accompanying these draft audit reports states as follows:

“The findings listed in the attachment include base year services that were no longer performed by the Provider yet were reimbursed in the Provider’s Medicaid nursing home rate during the rate period reviewed and services that should be billed under Medicare Part A in accordance with consolidated billing requirements as outlined in the Department of Health and Human Services Health Care Financing Administration Publication 60B dated November 27, 2000 (Transmittal B-00-67). Changes of this nature must be reported by the Provider in accordance with 10 NYCRR 86-2.27.”

Our letter spells out why this justification and the associated audit findings are inconsistent with state law, regulations, and policies and federal regulatory requirements. Among other things, we point out that these proposed disallowances “…contradict the state’s Medicaid statewide pricing methodology and the reporting requirements for these costs – which require the reporting of costs across all payor sources – and attempt to selectively disassemble the Medicaid statewide pricing system for nursing homes.” We conclude by urging OMIG to immediately discontinue its policy of disallowing the costs of services such as laboratory and radiology in their entirety from nursing home Medicaid rates.

OMIG is currently reviewing our letter and plans to discuss it with us in the near future. Members that receive draft audit notices on this issue may want to consider objecting to them and/or seeking extensions of time until we have further clarity on the future of these audits.

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