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Medicaid Inspector General, Office of the

Agency Web Site: http://omig.ny.gov/Link to External Website

Mission

The Office of the Medicaid Inspector General (OMIG) preserves 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 the Medicaid program. In fulfilling this role, the Office conducts and supervises all prevention, detection, and investigation activities and makes recommendations to these agencies for improvement. In addition, the Medicaid Inspector General works closely with the Attorney General’s Medicaid Fraud and Control Unit (MFCU) and Federal and local law enforcement officials.

Organization and Staffing

OMIG is headed by the Medicaid Inspector General, who is appointed by the Governor. The agency is organized into seven major business units: The Executive Office, Division of Medicaid Audit, Division of Medicaid Investigations, Division of System Utilization and Review, Division of Administration, and Office of Counsel.

Budget Highlights

The Executive Budget recommends $50 million for OMIG and a workforce of 426 FTE maintaining the funding and workforce target from the FY 2018 budget. Additionally, the Executive Budget supports initiatives to expand the authority of the Office of the Medicaid Inspector General (OMIG) to recover overpayments to Medicaid managed care organizations (MCO) by expanding OMIGs fining authority, requiring MCOs to report all potential fraud, waste, or abuse, and allowing for the recovery of overpayments from MCO subcontractors or providers. These initiatives will save $30.0 million in FY 2019 and $20.0 million in FY 2020.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Program Highlights

Medicaid Audit

OMIG staff conduct audits and reviews of Medicaid providers to determine compliance with program requirements and to identify improper Medicaid payments. Staff has knowledge about various types of medical and clinical providers and has audit experience in a broad range of health care programs. This affords OMIG the opportunity to develop, coordinate, and implement a broad spectrum of statewide Medicaid projects.

Medicaid Investigations

OMIG staff continuously monitor the Medicaid program for evidence of fraud and abuse. Staff respond to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities. Additionally, staff conduct investigations of providers furnishing dental, mental, medical care, and support services which include prescriptions, transportation, personal assistance, counseling, and complete care in nursing home or hospital settings. Investigations are also conducted of Medicaid recipients who abuse and/or defraud the Medicaid system by submitting false application information to qualify for benefits, drug diversion, and card loaning.

ALL FUNDS
APPROPRIATIONS
(dollars)
Category Available
FY 2018
Appropriations
Recommended
FY 2019
Change From
FY 2018
Reappropriations
Recommended
FY 2019
State Operations 50,021,000 50,021,000 0 30,595,000
Total 50,021,000 50,021,000 0 30,595,000

ALL FUND TYPES
PROJECTED LEVELS OF EMPLOYMENT BY PROGRAM
FILLED ANNUAL SALARIED POSITIONS
Program FY 2018
Estimated FTEs
03/31/18
FY 2019
Estimated FTEs
03/31/19
FTE Change
Medicaid Audit and Fraud Prevention
General Fund 214 214 0
Special Revenue Funds - Federal 212 212 0
Total 426 426 0

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY FUND TYPE
APPROPRIATIONS
(dollars)
Fund Type Available
FY 2018
Recommended
FY 2019
Change
General Fund 19,426,000 19,426,000 0
Special Revenue Funds - Federal 30,595,000 30,595,000 0
Total 50,021,000 50,021,000 0

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY PROGRAM
APPROPRIATIONS
(dollars)
Program Available
FY 2018
Recommended
FY 2019
Change
Medicaid Audit and Fraud Prevention
General Fund 19,426,000 19,426,000 0
Special Revenue Funds - Federal 30,595,000 30,595,000 0
Total 50,021,000 50,021,000 0

STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Personal Service Regular
(Annual Salaried)
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 15,733,000 0 15,630,000 0
Total 15,733,000 0 15,630,000 0
STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Temporary Service
(Nonannual Salaried)
Holiday/Overtime Pay
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 28,000 0 75,000 0
Total 28,000 0 75,000 0

STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Supplies and Materials
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 3,693,000 0 355,000 0
Total 3,693,000 0 355,000 0
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Travel Contractual Services
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 220,000 0 2,918,000 0
Total 220,000 0 2,918,000 0
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Equipment
Amount Change
Medicaid Audit and Fraud Prevention 200,000 0
Total 200,000 0

STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED
(dollars)
Program Total Personal Service
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 30,595,000 0 15,733,000 0
Total 30,595,000 0 15,733,000 0
STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2019 RECOMMENDED CONTINUED
(dollars)
Program Nonpersonal Service
Amount Change
Medicaid Audit and Fraud Prevention 14,862,000 0
Total 14,862,000 0

Note: Most recent estimates as of 01/16/2018

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