Andrew M. Cuomo


Dennis Rosen

Acting Medicaid Inspector General

NYS Medicaid Inspector General Releases Fiscal Year 2014-15 Work Plan

The 2014-15 OMIG Work Plan The New York State Office of the Medicaid Inspector General (OMIG) released its State Fiscal Year 2014-15 Work Plan, highlighting areas of focus in OMIG’s efforts to fight fraud, improve integrity and quality, and save taxpayer dollars.  This Work Plan details dozens of programs that will be reviewed over the period of April 1, 2014 through March 31, 2015.

 “Taxpayers depend on OMIG to fight fraud, improve integrity, and save taxpayer dollars. Our annual work plan is a roadmap to our efforts over the next 12 months,” said Medicaid Inspector General James C. Cox.

The work organizes OMIG’s work within business line teams (BLTs), an innovation Cox developed within OMIG during the early days of his tenure as Medicaid Inspector General.  BLTs consist of establishing teams of personnel with experience within the various parts of OMIG—auditors, investigators, clinicians, attorneys, and technicians—bringing together expertise to focus and expedite work production while simultaneously ensuring accuracy.   “BLTs help OMIG to operate with improved efficiency, conduct more thorough reviews and investigations, and tactically deploy resources where they are needed the most,” Cox added.  BLT coordination improves referrals to law enforcement and potential prosecution.

OMIG uses BLTs to focus on finding individuals who commit fraud and abuse.  Recent actions have included the identification of dozens of fraudulent providers and individuals who will face exclusion from participating in the Medicaid program or even criminal charges because of inappropriate and/or fraudulent acts.  

The BLT approach has paid financial dividends.  In calendar year 2013, preliminary OMIG recoveries topped $851 million dollars–a new record for OMIG, and the highest ever recovered in a single year by any state.

Recoveries do not tell the whole story of Medicaid program improvement.  New York State’s health care providers, as well as their compliance officers, and billing and coding staff, are following OMIG’s lead in strengthening their adherence to the rules of the Medicaid program.  “We are committed to ensuring fair consideration to New York’s providers, enrollees, and taxpayers as we fulfill the work outlined in this plan,” said Cox.

Available at the agency’s Web site, the Work Plan for State Fiscal Year 2014-15 reflects work that serves as the foundation for the state’s future efforts as the agency assures that providers meet program quality standards for Medicaid enrollees in a system free of waste, fraud, abuse, and improper payments.

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. Tips can be completely anonymous, and OMIG investigates information from all calls.

The mission of the Office of the Medicaid Inspector General 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 high-quality patient care.