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New York State Office of the

Medicaid Inspector General


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


About OMIG

Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting a high quality of patient care.

OMIG Vision Plan

Responsibilities of the Office of the Medicaid Inspector General

The Office of the Medicaid Inspector General (OMIG) is an independent entity created within the New York State Department of Health to improve and preserve 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 Medicaid. In carrying out its mission, the office conducts and supervises all prevention, detection, audit, and investigation efforts and coordinates these activities with the:

In addition, the Medicaid Inspector General works closely with the Attorney General’s Medicaid Fraud and Control Unit (MFCU) and works to strengthen partnerships with federal and local law enforcement agencies.

  1. To coordinate, to the greatest extent possible, activities to prevent, detect, and investigate medical assistance program fraud and abuse among the following: the Department of Health; the Offices of Mental Health, Alcoholism and Substance Abuse Services, Temporary and Disability Assistance, and Children and Family Services; the Commission on Quality of Care and Advocacy for Persons with Disabilities; the Office for People with Developmental Disabilities; Department of Education; the fiscal agent employed to operate the Medicaid management information system; local governments and entities; and to work in a coordinated and cooperative manner with, to the greatest extent possible, the Deputy Attorney General for Medicaid Fraud Control; the Welfare Inspector General, federal prosecutors, district attorneys, the special investigative unit maintained by each health insurer operating within the state, and the State Comptroller;
  2. To solicit, receive, and investigate complaints related to fraud and abuse within the medical assistance program;
  3. To keep the governor, attorney general, state comptroller, temporary president and minority leader of the senate, the speaker and the minority leader of the assembly, and the heads of agencies with responsibility for the administration of the medical assistance program apprised of efforts to prevent, detect, investigate, and prosecute fraud and abuse within the medical assistance program;
  4. To pursue civil and administrative enforcement actions against any individual or entity that engages in fraud, abuse, illegal or inappropriate acts or unacceptable practices perpetrated within the medical assistance program, including but not limited to:
    1. referral of information and evidence to regulatory agencies and licensure boards;
    2. withholding payment of medical assistance funds in accordance with state and federal laws and regulations;
    3. imposition of administrative sanctions and penalties in accordance with state and federal laws and regulations;
    4. exclusion of providers, vendors, and contractors from participation in the program;
    5. initiating and maintaining actions for civil recovery and, where authorized by law, seizure of property or other assets connected with improper payments; and entering into civil settlements; and
    6. recovery of expended medical assistance funds from those who engage in fraud, abuse, illegal or inappropriate acts perpetrated within the medical assistance program. In the pursuit of such civil and administrative enforcement actions under this subdivision, the inspector shall consider the quality and availability of medical care and services and the best interest of both the medical assistance program and recipients;
  5. To make information and evidence relating to suspected criminal acts which he or she may obtain in carrying out his or her duties available to appropriate law enforcement officials and to consult with the deputy attorney general for Medicaid fraud control, the welfare inspector general, and other state and federal law enforcement officials for coordination of criminal investigations and prosecutions.

    The inspector shall refer suspected fraud or criminality to the Deputy Attorney General for Medicaid fraud Control and make any other referrals to such deputy attorney general as required or contemplated by federal law. At any time after such referral, with ten days written notice to the deputy attorney general for Medicaid fraud control or such shorter time as such deputy attorney general consents to, the inspector may additionally provide relevant information about suspected fraud or criminality to any other federal or state law enforcement agency that the inspector deems appropriate under the circumstances;

  6. To subpoena and enforce the attendance of witnesses, administer oaths or affirmations, examine witnesses under oath, and take testimony;
  7. To require and compel the production of such books, papers, records, and documents as he or she may deem to be relevant or material to an investigation, examination or review undertaken pursuant to this section;
  8. To examine and copy or remove documents or records of any kind related to the medical assistance program or necessary for the inspector to perform its duties and responsibilities that are prepared, maintained or held by or available to any state agency or local governmental entity the patients or clients of which are served by the medical assistance program, or which is otherwise responsible for the control of fraud and abuse within the medical assistance program; provided, however, that any such information be afforded confidentiality protection as provided for under state and federal law. The removal of records shall be limited to those circumstances in which a copy thereof is insufficient for an appropriate legal or investigative purpose, provided that in such instances the copy and return of such original, or copy where the original is required for an appropriate legal or investigative purpose, is expedited and readily accessible in accordance with the care and treatment of a patient;
  9. To recommend and implement policies relating to the prevention and detection of fraud and abuse; provided however, that the consent of the Attorney General shall be obtained prior to the implementation of any policy that shall affect the operations of the Office of the Attorney General;
  10. To monitor the implementation of any recommendations made by the office to agencies or other entities with responsibility for administration of the medical assistance program;
  11. To prepare cases, provide testimony, and support administrative hearings and other legal proceedings;
  12. To review and audit contracts, cost reports, claims, bills, and all other expenditures of medical assistance funds to determine compliance with applicable federal and state laws and regulations and take such actions as are authorized by federal or state laws and regulations;
  13. To work with the fiscal agent employed to operate the Medicaid management information system to optimize the system;
  14. To work in a coordinated manner with relevant agencies in the implementation of information technology relating to the prevention and identification of fraud and abuse in the medical assistance program, including the surveillance utilization review system and other automated systems pursuant to paragraph (b) of subdivision eight of section three hundred sixty-seven-B of the social services law;
  15. To conduct educational programs for medical assistance providers, vendors, contractors, and recipients designed to limit fraud and abuse within the medical assistance program;
  16. To, in conjunction with the Department of Health commissioner, develop protocols to facilitate the efficient self-disclosure and collection of overpayments and monitor such collections, including those that are self-disclosed by providers. The provider's good faith self-disclosure of overpayments may be considered as a mitigating factor in the determination of an administrative enforcement action;
  17. To receive and to investigate complaints of alleged failures of state and local officials to prevent, detect, and prosecute fraud and abuse in the medical assistance program;
  18. To implement and amend, as needed, rules and regulations relating to the prevention, detection, investigation, and referral of fraud and abuse within the medical assistance program and the recovery of improperly expended medical assistance program funds consistent with the provisions of this title;
  19. To conduct, in the context of the investigation of fraud and abuse, on-site facility and office inspections;
  20. To take appropriate action to ensure that the medical assistance program is the payor of last resort;
  21. To annually submit a budget request, for the ensuing state fiscal year, to the division of budget, provided that the office's budget request shall not be subject to review, alteration or modification by the commissioner or any other entity or person prior to its submission to the division of budget; and
  22. To perform any other functions that are necessary or appropriate to fulfill the duties and responsibilities of the office in accordance with federal and state law.

For more information about the Statute establishing the Office of the Medicaid Inspector General click on this link