In 2013, the New York State Office of the Medicaid Inspector General (OMIG) achieved significant results in several areas of Medicaid program integrity. Some of the highlights include:
Recovered a record $879 million. With these record breaking figures in 2013, OMIG now has recovered more than $1.73 billion in improperly expended Medicaid funds over the past three years. This is a 34 percent increase over the prior three year period.
Identified more than $226 million through audit activities. These activities included record breaking years in the areas of fee-for-service and managed care audits, with $104 million and $47 million identified for recovery, respectively. Additionally, over $16 million self-disclosed by providers; over $7.2 million identified through the work of the County Demonstration program; and, over $7 million resulted from data mining initiatives.
$6.7 million resulting from OMIG investigations. These investigative financial activities are the result of OMIG’s collaborative work with several law enforcement partners. These figures represent the highest total in five years.
Saved more than $2 billion for taxpayers through cost savings initiatives. OMIG utilized various cost saving program initiatives, including pre-payment reviews and corporate integrity agreement monitoring, to generate savings to the Medicaid program. These cost savings measures yielded a three year estimated total of $7.06 billion, an almost $2 billion increase over the previous three years.
Suspended $46 million in payments to providers under the Affordable Care Act. OMIG pursued credible allegations of fraud under the federal Affordable Care Act (ACA) with the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU), and suspended payments to prevent inappropriate expenditures of Medicaid funds.
Excluded or Terminated More Than 700 Providers. OMIG ended Medicaid program participation for 685 providers; and, 16 providers had their Medicaid contract terminated for licensure actions. These providers can no longer work in Medicaid-funded positions in health care-oriented businesses and organizations, or submit claims to the Medicaid program.
Additionally, OMIG referred 164 providers to MFCU. These referrals may lead to potential criminal prosecution.