The New York State Office of the Medicaid Inspector General (OMIG) is the New York State (NYS) Medicaid program’s “watchdog” agency. (Last year they recovered in excess of $851 million from providers and others.) It is one of the most prominent state OMIG’s in the country, so providers in other states keep an eye on what the NYS OMIG does even if they do not operate in New York. The NYS OMIG issues a Work Plan each year outlining the programs OMIG plans to review for that year regarding fraud and abuse enforcement. OMIG recently released its State Fiscal Year 2014-2015 Work Plan for work to be performed from April 1, 2014 through March 31, 2015.
The Work Plan organizes OMIG’s efforts into Business Line Teams (BLTs), or specialized multi-disciplinary teams that help coordinate program integrity activities with other federal, state and local partners. Each BLT consists of auditors, investigators, clinicians, attorneys and technicians, all of whom have different areas of expertise and experience.
This year’s Work Plan delineates the following categories of services assigned to the BLTs:
This year’s Work Plan includes multiple BLT and individual BLT strategies and focuses on expanding review of Medicaid managed care and compliance activities. The multiple BLT activities appear to be a continuation of those from 2013, including, for example, corporate integrity agreement enforcement, identification of providers who have engaged in kickbacks and inducements, prepayment review and self-disclosure portal functions. Notably, this Work Plan reintroduces (previously mentioned in the 2011 Work Plan) undercover investigator operations to assist in discovering quality-of-care issues, billing problems, and systematic fraud, as well as gather information on how organizations operate and the types of drugs subject to abuse.