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OMIG Releases Annual Report for 2015

The New York State Office of the Medicaid Inspector General (OMIG) has released its 2015 Annual Report, which details recoveries, cost saving efforts, and other program integrity efforts undertaken during 2015.

OMIG claims more than $1.8 billion in cost savings to the Medicaid program, although most of this amount is attributable to the state’s third party liability vendor, HMS. HMS obtains information from insurance carriers across the country and matches this identified coverage against New York Medicaid beneficiaries to identify third party insurance coverages. Medicaid pays after any other insurer. According to the report, this pre-payment insurance verification saved over $1.5 billion in 2015. OMIG also recovered over $339 million from various audits during 2015.

The report includes a summary of program integrity activities across provider and program lines. Highlights include:

  • Audits: OMIG initiated 2,515 audits in 2015 and finalized 1,016 audits. OMIG finalized 234 FFS audits in 2015, identifying overpayments of over $51 million.
  • Referrals: OMIG is required to refer suspected fraud and criminal conduct to the Attorney General’s Medicaid Fraud Control Unit (MFCU). In 2015, OMIG referred 192 providers to MFCU and 954 providers to outside state, city, and federal agencies.
  • Managed Long Term Care (MLTC): Four audits were conducted resulting in $3.2 million in overpayments.
  • Social Adult Day Care (SADC): The Department of Health (DOH), in conjunction with the New York State Office for the Aging and OMIG, established a new certification process for SADC providers. The SADC certification is now mandatory for all SADC entities that contract with MLTC plans.
  • Nursing Home Capital: OMIG worked with DOH’s Bureau of Long Term Care Reimbursement to streamline the appeal process for the capital component of nursing home Medicaid rates through a capital component attestation process.

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