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NY releases work plan, fraud unit annual report

Healthcare Auditing Weekly, May 5, 2009

The New York State Office of the Medicaid Inspector General (OMIG) released its second annual work plan for fiscal year 2009-10.

The work plan will provide a “roadmap for our endeavors for this fiscal year and beyond,” said James Sheehan, New York State Medicaid Inspector General.

The OMIG is also expanding its office to accommodate increasing audits, investigations, and surveillance activities across the state, Sheehan said. In 2008, the state’s Medicaid Fraud Control Unit (MFCU) obtained 143 conviction and secured settlements and court orders totaling $263.5 million in civil damages and criminal restitution, according to a report from New York State Attorney General Andrew Cuomo. This amount is more than double what the MFCU recovered in 2007, he said.

The state agency will continue its efforts through its work plan, which includes audits and reviews in several avenues of healthcare (e.g. freestanding ambulatory surgery services, durable medical equipment and supplies, home health, and hospitals). The following are areas state auditors will focus on with regards to hospitals:

• Credit balances
• Duplicate clinic claims
• Fee-for-service payments when patient is enrolled in Medicaid Managed Care
• Hospital newborn fee-for-service
• Ninety-day billing exception codes
• Payment for Medicare coinsurance and deductibles
• Physician and hospital financial relationships
• Review of DRG coding

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