Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars
OMIG detects schemes of fraud, curbs unacceptable practices, and improves quality of care as it relates to Medicaid fraud, waste, and abuse. Investigations focus on finding those providers who commit fraud and abuse to ensure that these individuals will no longer be able to participate in the State's Medicaid program. Fraud and abuse discoveries result in the initiation of an administrative action or a referral for civil and criminal prosecution. Administrative actions include the exclusion or termination of providers from the Medicaid Program, monetary penalties, recovery of Medicaid funds, and suspension of Medicaid privileges for a specified period of time. Provider issues that could result in criminal prosecution are referred to the New York State Office of the Attorney General's Medicaid Fraud Control Unit (MFCU) for possible criminal prosecution. Providers are also referred to other government agencies including the Office of Professional Medical Conduct, the Bureau of Narcotic Enforcement, New York State Department of Education, the Office of the Welfare Inspector General, and the Health and Human Services Office of the Inspector General.
Investigations are also conducted on allegations related to Medicaid consumer eligibility, misuse of benefits cards, and cases where consumers lend or rent their benefits cards to others to obtain medical benefits for which they are not entitled. OMIG also coordinates with local, state, and federal law enforcement to investigate consumers defrauding Medicaid and refers those consumers for prosecution.If you suspect fraud or abuse, call toll free: