On January 3, 2024, the New York State Office of the Medicaid Inspector General (“OMIG”) posted its 2024 Work Plan. This is the first update since its 2019 – 2020 Work Plan and OMIG notes that the Work Plan does not reflect an exclusive list of its initiatives for the period.

The 2024 OMIG Work Plan includes links to OMIG’s Self-Disclosure materials, audit protocols and other OMIG resources.

A high-level review of the Work Plan identifies the following areas of OMIG’s focus:

  1. Compliance Program Reviews – provider and Medicaid Managed Care Organization (MMCO) compliance program reviews will assess if compliance programs are implemented and operating.
  2. Self-Disclosure – OMIG’s Self-Disclosure Unit will continue to process submissions received under the Abbreviated Self-Disclosure Process and Full Self-Disclosure Process that OMIG issued in 2023. Additionally, the Self-Disclosure Process is cited as a method for providers to report damaged, lost or destroyed records that support providers’ Medicaid claims.
  3. Medicaid Managed Care Audits – the Work Plan outlines eleven areas of focus in its MCO audits, as well as OMIG’s continued review of Medicaid Managed Care Operating Reports (MMCORs) and OMIG’s monitoring of MMCOs’ Special Investigations Units’ (SIUs) results.
  4. Provider Audits – the Work Plan outlines some specifics related to the audits that are planned for the following provider types:
    • Long-Term Care Services
    • Home Health & Community-Based Services
    • Behavioral Health/Addiction Services and Supports
    • Person-Centered Services and Supports
    • Early Intervention (EI)/Pre-School and School-Supported Health Services (SSHS)
    • Pharmacy
    • Transportation – non-emergency services (Transportation Ambulette and Transportation Taxi/Livery).
    • Durable Medical Equipment (DME)
  5. Third Party Liability Match – to confirm that Medicaid is the payor of last resort.
  6. Recovery Audit Contract (RAC) Reviews – interaction with RAC auditors to collect overpayments that could be undetected by reviewing Medicaid claims data alone.
  7. Casualty & Estate/Medicaid Liens Reconciliations – coordination with its contractor, NYS Department of Health (“DOH”) and Local Department of Social Services to address Medicaid liens.
  8. Investigations –
    • Credentialing Verification Reviews (CVRs) – investigations initiated to determine providers’ compliance with Medicaid requirements and to educate providers on Medicaid guidelines.
    • Pre-Payment Review – review of pended Fee-for-Service claims across a variety of providers. The new focus will be on managed care billings and patterns of practice with expansion into specialties like family planning, dental, DME, physician and transportation.
    • Explanation of Benefits (EOMB) – correspondence with Medicaid beneficiaries to confirm receipt of services billed by providers.
    • Education Letters – letters issued by OMIG based on investigative findings to educate providers.
    • Provider Enrollment and Reinstatement – secondary review of provider enrollment applications.
  9. System Match – data mining tool used by OMIG to identify improper claim conditions for potential recoveries of inappropriate Medicaid payments. Project areas for 2024 include:
    • Physician Services in OMH Licensed Clinics
    • Partial Hospitalization
    • Transportation
  10. Healthcare Worker Bonus – OMIG to work with DOH to confirm the payments are appropriately distributed.
  11. Pharmacy/Drug Diversion – evaluation of enrolled pharmacy provider’s compliance with NYS Medicaid pharmacy program requirements, and applicable laws and regulations pertaining to the practice of pharmacy and operation of pharmacies. It is expected that more frequent CVRs of pharmacies across the state will occur.
  12. Collections – management of a provider Financial Hardship program that will allow for an extended repayment when a provider overpayment has been identified.

Please contact Matthew Babcock at mbabcock@harrisbeach.com if you would like to engage Harris Beach to review your compliance plan or to assist in development of a compliance plan and supporting policies that that meet the new requirements.

This alert is not a substitute for advice of counsel on specific legal issues.

Harris Beach has offices throughout New York state, including Albany, Buffalo, Ithaca, Long Island, New York City, Rochester, Saratoga Springs, Syracuse and White Plains, as well as Washington D.C., New Haven, Connecticut and Newark, New Jersey.