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Medicaid Inspector General

Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.


Report Details the Final Tally of Medicaid Recoveries and Cost Savings That Were Released Earlier This Year

Avoiding Unnecessary Costs to the Medicaid Program Saved Taxpayers More Than $2 Billion

$879 Million in Medicaid Overpayments Recovered in 2013 and $1.73 Billion Over Last Three Years

Albany, NY (Oct. 9, 2014) - The New York State Office of the Medicaid Inspector General (OMIG) today released its 2013 Annual Report. Representing the final totals for Medicaid recoveries and cost savings in 2013, the report shows that OMIG's efforts saved taxpayers more than $2 billion and generated a record $879 million in recoveries last year. Over the last three years, Medicaid recoveries exceeded $1.73 billion, which represents a 34-percent increase over the prior three-year period.

“Ensuring the integrity of the state's Medicaid program is an essential component of Governor Cuomo's ongoing, successful initiative to enhance the quality of care in the state's health care delivery system while continuing to reduce costs,” Medicaid Inspector General James C. Cox said. “These record-setting recoveries and billions in cost savings play a major role in protecting the integrity of the state's Medicaid program and ensuring New Yorkers have access to high-quality services.”

These results and other achievements are detailed in OMIG's 2013 Annual Report, which is available on the OMIG website at: http://www.omig.ny.gov/images/stories/annual_report/2013_annual_report.pdf

Highlights from the 2013 Annual Report include:

  • OMIG identified more than $226 million through audit activities, which included record-breaking years in the areas of fee-for-service and managed care audits, with $104 million and $47 million identified for recovery, respectively. Additionally, more than $16 million was self-disclosed by providers, more than $7.2 million was identified through the work of the County Demonstration program, and more than $7 million resulted from data mining initiatives.

  • Through its array of program initiatives, including pre-payment reviews and corporate integrity agreement (CIA) monitoring, OMIG avoided more than $2 billion in unnecessary costs to the Medicaid program. These cost-savings measures have generated a three-year estimated total of $7.06 billion, a nearly $2 billion increase over the previous three years.

  • CIA monitoring and enforcement efforts alone resulted in more than $55 million of these avoided costs to the Medicaid program. CIAs are offered by OMIG to providers with a history of program integrity issues as an alternative to exclusion from the Medicaid program, when exclusion might lead to extenuating circumstances such as service shortages within a given geographical area.

  • To prevent inappropriate expenditures of Medicaid funds, OMIG and the New York State Attorney General's Medicaid Fraud Control Unit pursued credible allegations of fraud under the federal Affordable Care Act, which resulted in the suspension of approximately $46 million in payments to providers.

  • In 2013, OMIG ended Medicaid program participation for more than 702 providers. As a result of OMIG's efforts, these providers can no longer work in Medicaid-funded positions in health care-oriented businesses and organizations, or submit claims to the Medicaid program. Additionally, OMIG referred 164 providers to the Medicaid Fraud Control Unit for potential criminal prosecution.

  • OMIG's investigative unit identified more than $6.7 million, as a result of OMIG's collaborative work with several law enforcement partners, which represents the highest total in five years.

  • New Yorkers can assist the Office of the Medicaid Inspector General in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents. OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG's fraud hotline at 1-877-87-FRAUD or visit the OMIG website at www.omig.ny.gov Tips can be completely anonymous, and OMIG investigates information from all calls received.

    Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices in the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
OMIG Webinar 22 "The OMIG Exclusion and Reinstatement Process" is now posted. Please click this link to access the recording of the webinar. If you have questions regarding the webinar, please email them to information@omig.ny.gov and we will collect them and post a frequently asked questions document.
The Office of the Medicaid Inspector General (OMIG) received a complaint in September 2011 alleging that Licensed Practical Nurse Tammy Beth Wojtach was billing Medicaid for services not rendered. Her fraudulent billing was discovered after she left a position in which she cared for a 10-year-old recipient with cerebral palsy. When the new nurse submitted bills for the same recipient, the claims were denied by Medicaid because Wojtach had already used all of the approved hours from the patient’s Medicaid prior authorization. OMIG subsequently received additional information indicating that Wojtach was billing for services while she was on a cruise in the Caribbean. OMIG investigators obtained and analyzed relevant Medicaid data, conducted interviews, and referred the case to the Attorney General’s Medicaid Fraud Control Unit. On November 19, 2013, Wojtach was arrested by the New York State Attorney General’s Office. She was arraigned in Central Islip on a felony charge of third-degree grand larceny related to the matter OMIG had referred. On January 7, 2014, Wojtach pleaded guilty to the lesser offense Petit Larceny. She was sentenced on March 4 in Suffolk County to restitution of $18,299 and three years of probation. OMIG excluded Wojtach from the Medicaid program effective May 21, 2014.
Dr. Andrew Russo became the subject of a claims review after potential billing irregularities were identified. Before a full medical review could be initiated, however, Russo stopped billing Medicaid, and in October 2013 he allowed the registration on his medical license to lapse. OMIG investigators researched Russo’s inactivity, only to discover that he had been arrested and charged with a Class C Felony for the Criminal Sale of a Prescription Controlled Substance. On June 26, 2013, Russo pleaded guilty to the charges and was sentenced to five years of probation. OMIG prepared a Notice of Immediate Agency Action (NOIAA) to exclude Dr. Russo from the Medicaid program.

The Affordable Care Act requires Medicaid providers to "self-disclose" - to report and return any dollars that the provider should not have received. In order to aid providers in this process, on August 6th, 2014 the Office of the Medicaid Inspector General (OMIG) hosted a webinar that shows Medicaid providers in New York how to self disclose. Self disclosure efforts by OMIG and providers yielded over $20 million in returned payments during OMIG's last reporting year. OMIG suggests that every Medicaid provider view Webinar #21 - Self Disclosure to understand how the process works, and what they can do as a provider to comply with this important requirement.

Report Fraud

Report FraudYou can help stop Medicaid fraud: Call OMIG’s Fraud Hotline at 1-877-87 FRAUD (1-877-873-7283), or click here to file a complaint electronically.

Check for Terminations and Exclusions

Check for Medicaid Terminations and ExclusionsThe OMIG may sanction some providers by excluding them from participating in the Medicaid program. These providers are excluded from offering services to Medicaid enrollees and also cannot be paid with Medicaid dollars. Prior to adding new staff members, employers should check to see if prospective employees have been excluded from Medicaid. To make it easier to perform such a check, OMIG set up a dedicated service to check the status of any exclusion.

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Report Details the Final Tally of Medicaid Recoveries and Cost Savings That Were Released Earlie [ ... ]

OMIG Webinar 22 "The OMIG Exclusion and Reinstatement Process" is now posted. Please click this lin [ ... ]

Dr. Andrew Russo became the subject of a claims review after potential billing irregularities were i [ ... ]

The Office of the Medicaid Inspector General (OMIG) received a complaint in September 2011 alleging  [ ... ]

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Start a Self Disclosure

Start a Self DisclosureAnytime a health care organization discovers that it was paid more than it was due, this should be reported to OMIG. Our Self-Disclosure section provides information for health care organizations to complete the recently revamped self-disclosure process.

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