New York State Office of the

Medicaid Inspector General


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


2014 Compliance Program certification information and forms for the December 2014 Certification period have been posted. They are available on OMIG’s Compliance site.
Frequently asked questions and answers regarding the compliance certification process for 2014, covered in OMIG Webinar 23 have now been posted. They can be accessed at OMIG's webinar site.

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.

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    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 #23 "OMIG's Compliance Certification Process: December Annual & Enrolling Provider" is now posted. This webinar provides a high-level overview of the annual certification requirements and introduces the forms that required providers must use to complete the process. This webinar can be accessed by clicking here.
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.