2009-2010 Office of the Medicaid Inspector General Work Plan Released

2009-2010 OFFICE OF THE MEDICAID INSPECTOR GENERAL WORK PLAN RELEASED    

The mission of the OMIG is to improve the efficiency and accountability of the NYS Medicaid program by preventing and detecting fraudulent, wasteful, and abusive practices. There are 70,000 Medicaid providers in NYS, with 4 million beneficiaries (and counting). In 2008, there were approximately 400 million claims processed. Payments to the providers amounted to $43.5 million in 2008.    OMIG is seeking to recover $1.6 billion from inception to 2011. During the first year OMIG recovered $215 million.    The work plan for 2009-2010 will include the follow areas:  

• Diagnostic and Treatment Centers; physical, speech and occupational therapies as well as HIV primary care services
• Durable Medical Equipment and Supplies
• Early Intervention
• Ambulatory Surgery Centers
• Home Health Services/Hospice Services
• Business arrangements and relationships for anti-kickback statues and self referrals by physicians to include fair market value rents, etc.
• Excessive services will be investigated in dentistry
• High volume services from providers including durable medical equipment, transportation and medications will be investigated
• Review of Medicare and Medicaid claims including overpayments or credit balances
• Prescription forgery

This list is long, but the OMIG initiatives are not going away. The key to staying on track is documentation.  All services ordered should be well-documented in the chart notes. 

For more information, please feel free to contact John Pellitteri, Partner & Healthcare Niche Practice Leader, at (516) 336-2470 or via e-mail at jpellitteri@grassicpas.com.