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In an effort to eliminate and prevent fraud, waste and abuse, and in seeking to ensure the integrity of the Medicaid Program, the NYS Office of the Medicaid Inspector General (OMIG) working closely with the Department of Health, has for a second year released its Medicaid Work Plan. This 2009-2010 Work Plan serves as a “road map”, enabling NYS to develop competencies, and review expenditures and vulnerabilities, while simultaneously giving providers and the public a picture of OMIG’s activities for the current fiscal year for planning and compliance.
Since its creation in November 2006, the OMIG has emphasized many areas of program integrity that relate to transparency and communication with health care providers, the prevention and early detection of any improper payments, the development of effective internal compliance programs and controls using effective data mining and analysis. Significant financial goals for the OMIG in terms of fiscal recoveries have been set by NY’s Governor and Legislature.
OMIG, the Department of Health, and the Medicaid Fraud Control Unit of the NYS’ Attorney General’s Office have collaborated to meet and actually exceed the $215 million federal fiscal year 2008 recoupment goal. The goal for 2009 increased to $322 million! With NYS’ fiscal situation being what it is one would expect this goal to continue increasing.
If your organization’s programming receives Medicaid funding, we recommend that you become familiar with the areas of provider compliance regulations specific to your programs, so that periodic self-reviews can be done prior to any NYS agency review. Your organization’s compliance with these regulations will help to ensure that correct billing patterns will decrease the need for any future recovery of overpayments. The OMIG Medicaid Work Plan can be downloaded from www.omig.state.ny.us. Plans, regulations and audit processes applicable to Hospitals, Assisted Living Facilities, Home Health Services, Managed Care, Office of Alcoholism and Substance Abuse Services, Office of Children and Family Services, Office of Mental Health, Office of Mental Retardation and Developmental Disability and many others are available.
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