Medicaid Inspector General, Office of the

Agency Web Site: https://omig.ny.gov/

Mission

The Office of the Medicaid Inspector General (OMIG) preserves the integrity of the Medicaid program by conducting and coordinating fraud, waste and abuse control activities for all State agencies responsible for services funded by the Medicaid program. In fulfilling this role, the Office conducts and supervises all prevention, detection, and investigation activities and makes recommendations to these agencies for improvement. In addition, the Medicaid Inspector General works closely with the Attorney General’s Medicaid Fraud and Control Unit (MFCU) and Federal and local law enforcement officials.

Organization and Staffing

OMIG is headed by the Medicaid Inspector General, who is appointed by the Governor. The agency is organized into seven major business units: The Executive Office, Division of Medicaid Audit, Division of Medicaid Investigations, Division of System Utilization and Review, Division of Administration, and Office of Counsel.

Budget Highlights

The Executive Budget recommends funding of $50 million and increasing the workforce target from the FY 2020 Enacted budget to 495 FTEs to allow the OMIG to engage with the Department of Health (DOH) on enhanced program integrity efforts aimed at identifying efficiencies and cost avoidance in the State’s Medicaid program, in particular through the establishment of an enterprise environment focused on applying data analytics and improved systems information to address the Medicaid cost crisis. Funding provided in the Executive Budget will be financed through increased audit recoveries and cost avoidance.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Briefing Book – Health Care (PDF)

Program Highlights

Medicaid Audit

OMIG staff conduct audits and reviews of Medicaid providers to determine compliance with program requirements and to identify improper Medicaid payments. Staff has knowledge about various types of medical and clinical providers and has audit experience in a broad range of health care programs. This affords OMIG the opportunity to develop, coordinate, and implement a broad spectrum of statewide Medicaid projects.

Medicaid Investigations

OMIG staff continuously monitor the Medicaid program for evidence of fraud and abuse. Staff respond to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities. Additionally, staff conduct investigations of providers furnishing dental, mental, medical care, and support services which include prescriptions, transportation, personal assistance, counseling, and complete care in nursing home or hospital settings. Investigations are also conducted of Medicaid recipients who abuse and/or defraud the Medicaid system by submitting false application information to qualify for benefits, drug diversion, and card loaning.

Note: Most recent estimates as of 01/29/2020