Office of the Medicaid Inspector General (OMIG) Audits

The dreaded letter from the Office of the Medicaid Inspector General:

“This letter is to advise you that the Office of the Medicaid Inspector general will conduct an audit of…”

Fill in the blank – base year, health recruitment and retention, dropped services, capital, Part B, appeal responses – the list goes on and on.

Aggressive searches for fraud, waste, and abuse among Medicaid providers are leading to more and more retroactive rate recalculations from New York State.

These letters are being dispatched by the State with increasing frequency, as a result of the federal Deficit Reduction Act of 2005 (DRA) which provided both incentives and penalties for states to begin a more aggressive policing of Medicaid costs, fraud and abuse. New York State has hired more than 700 investigators and auditors to search out areas where the State can save money on Medicaid expenditures. OMIG is pulling out all the stops to meet its mandated recoupment quotas. And the stories you hear are true – they are being very aggressive about it – pushing the limits and expanding interpretations.

What should you do when you’re audited?

The first thing you need to do is undertake a careful review of your own records. Then be prepared to stay involved in the audit, discuss and negotiate with OMIG and pursue legal action if necessary.That’s where the professionals of Rotenberg HealthCare Consulting can help. We know as much as anyone in New York State about the methodologies behind Medicaid reimbursement rates, what’s allowed and what’s not allowed, what case law has to say about it, what the rules are and what the exceptions to the rules allow.

Step-by-step, we help you through the process of providing OMIG with the materials they need for the audit, discussing your operations with OMIG auditors, championing your case, providing alternative arguments, reviewing OMIG adjustments and if necessary, appealing those adjustments. We also have experience and success representing providers at hearings as an advocate and as a witness. As with all our health care consulting work, you are assured that our professionals have extensive experience in the OMIG audit process.

After the audit, prevent future issues

We can help you with a regulatory compliance plan that will reduce the chances you find yourself with a second letter from OMIG.

Whether you’re facing an audit or hoping to prevent one, we can help you. Contact us.