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Audit of NY Office of Medicaid Inspector General

The latest developments with the NY Medicaid program relate to concerns about the performance of the state Office of Medicaid Inspector General (OMIG). The OMIG’s role is to ensure maximum efficiency of the program. Considering the constant chatter about possible program changes in order to save costs, the work of the OMIG is critical for all New York residents who rely on Medicaid assistance in any number of ways.

The OMIG identifies that its goal 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.”

However, many observers have grown worried that the office is not maximizing its capabilities, allowing unnecessary funds to go out, hurting the overall efficiency of the Medicaid program. Those concerns were likely amplified in recent weeks as information came out regarding the potential abuse of adult day care programs funded by Medicaid. In addition, a congressional panel recently issued sharp criticism of the NY Medicaid program. That panel noted that New York maintains the largest Medicaid program in the country ($56 billion), and that the ballooning costs may be related, in part, to poor investigation of Medicaid fraud and abuse. The federal government pays for a portion of all Medicaid services, and so federal decision-makers can play in role in state Medicaid policy,.

Considering the growing concern about the fraud prevention activity of the office, it is perhaps not surprising that the NY Comptroller’s office recently announced an audit of the OMIG. In a letter to the Medicaid Inspector General, NY Comptroller Thomas DiNaploi explained that the audit would be comprehensive, examining the results of various projects from the OIMG.

In other words, the audit will try to verify some of the recent claims by the office. For example, the OMIG recently noted that an education program at local hospitals on proper billing practices led to $2.54 billion in savings. Is that accurate? The audit will hopefully find out. In addition, the audit will hopefully identify if the outside contractors who are used as part of the fraud-prevention efforts are properly utilized to maximize their effectiveness. Some are concerned that those outside contractors are being paid too much for doing too little work.

Whatever the outcome, a more efficient system that ensure New York residents do not face damaging cutbacks should be welcome by all.

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