Medicaid Inspector General, Office of the
skip breadcrumbsAgency 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 $47 million, a decrease of $1.5 million from the FY 2021 Enacted Budget. OMIG's budget has effectively remain flat as there was an additional 27th pay period in FY 2021.
The Budget recommends a workforce of 515 full time equivalent employees (FTEs) and continues to support an increase of 35 FTEs as part of a workforce investment made in the FY 2021 Enacted Budget to support enhanced program integrity efforts. Funding for this workforce investment is 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.
| Category | Available FY 2021 |
Appropriations Recommended FY 2022 |
Change From FY 2021 |
Reappropriations Recommended FY 2022 |
|---|---|---|---|---|
| State Operations | 52,613,000 | 55,244,000 | 2,631,000 | 30,595,000 |
| Total | 52,613,000 | 55,244,000 | 2,631,000 | 30,595,000 |
| Program | FY 2021 Estimated FTEs 03/31/21 |
FY 2022 Estimated FTEs 03/31/22 |
FTE Change |
|---|---|---|---|
| Medicaid Audit and Fraud Prevention | |||
| General Fund | 223 | 258 | 35 |
| Special Revenue Funds - Federal | 222 | 257 | 35 |
| Total | 445 | 515 | 70 |
| Fund Type | Available FY 2021 |
Recommended FY 2022 |
Change |
|---|---|---|---|
| General Fund | 20,722,000 | 21,758,000 | 1,036,000 |
| Special Revenue Funds - Federal | 31,891,000 | 33,486,000 | 1,595,000 |
| Total | 52,613,000 | 55,244,000 | 2,631,000 |
| Adjustments: | |||
| Transfer(s) From | |||
| Health, Department of | |||
| General Fund | (1,296,000) | ||
| Special Revenue Funds - Federal | (1,296,000) | ||
| Appropriated FY 2021 | 50,021,000 | ||
| Program | Available FY 2021 |
Recommended FY 2022 |
Change |
|---|---|---|---|
| Medicaid Audit and Fraud Prevention | |||
| General Fund | 20,722,000 | 21,758,000 | 1,036,000 |
| Special Revenue Funds - Federal | 31,891,000 | 33,486,000 | 1,595,000 |
| Total | 52,613,000 | 55,244,000 | 2,631,000 |
| Program | Total | Personal Service Regular (Annual Salaried) |
||
|---|---|---|---|---|
| Amount | Change | Amount | Change | |
| Medicaid Audit and Fraud Prevention | 17,880,000 | 851,000 | 17,857,000 | 931,000 |
| Total | 17,880,000 | 851,000 | 17,857,000 | 931,000 |
| Program | Temporary Service (Nonannual Salaried) |
Holiday/Overtime Pay | ||
|---|---|---|---|---|
| Amount | Change | Amount | Change | |
| Medicaid Audit and Fraud Prevention | 13,000 | (15,000) | 10,000 | (65,000) |
| Total | 13,000 | (15,000) | 10,000 | (65,000) |
| Program | Total | Supplies and Materials | ||
|---|---|---|---|---|
| Amount | Change | Amount | Change | |
| Medicaid Audit and Fraud Prevention | 3,878,000 | 185,000 | 125,000 | (230,000) |
| Total | 3,878,000 | 185,000 | 125,000 | (230,000) |
| Program | Travel | Contractual Services | ||
|---|---|---|---|---|
| Amount | Change | Amount | Change | |
| Medicaid Audit and Fraud Prevention | 120,000 | (100,000) | 3,556,000 | 638,000 |
| Total | 120,000 | (100,000) | 3,556,000 | 638,000 |
| Program | Equipment | |
|---|---|---|
| Amount | Change | |
| Medicaid Audit and Fraud Prevention | 77,000 | (123,000) |
| Total | 77,000 | (123,000) |
| Program | Total | Personal Service | ||
|---|---|---|---|---|
| Amount | Change | Amount | Change | |
| Medicaid Audit and Fraud Prevention | 33,486,000 | 1,595,000 | 17,880,000 | 851,000 |
| Total | 33,486,000 | 1,595,000 | 17,880,000 | 851,000 |
| Program | Nonpersonal Service | |
|---|---|---|
| Amount | Change | |
| Medicaid Audit and Fraud Prevention | 15,606,000 | 744,000 |
| Total | 15,606,000 | 744,000 |
Note: Most recent estimates as of 01/19/2021