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New York State Office of the

Medicaid Inspector General

Fighting Fraud. Improving Integrity and Quality. Saving Taxpayer Dollars.

The Office of the Medicaid Inspector General (OMIG) received a complaint in September 2011 alleging that Licensed Practical Nurse Tammy Beth Wojtach was billing Medicaid for services not rendered. Her fraudulent billing was discovered after she left a position in which she cared for a 10-year-old recipient with cerebral palsy. When the new nurse submitted bills for the same recipient, the claims were denied by Medicaid because Wojtach had already used all of the approved hours from the patient’s Medicaid prior authorization. OMIG subsequently received additional information indicating that Wojtach was billing for services while she was on a cruise in the Caribbean. OMIG investigators obtained and analyzed relevant Medicaid data, conducted interviews, and referred the case to the Attorney General’s Medicaid Fraud Control Unit. On November 19, 2013, Wojtach was arrested by the New York State Attorney General’s Office. She was arraigned in Central Islip on a felony charge of third-degree grand larceny related to the matter OMIG had referred. On January 7, 2014, Wojtach pleaded guilty to the lesser offense Petit Larceny. She was sentenced on March 4 in Suffolk County to restitution of $18,299 and three years of probation. OMIG excluded Wojtach from the Medicaid program effective May 21, 2014.

Providers Should View the Self Disclosure Webinar

The Affordable Care Act requires Medicaid providers to "self-disclose" - to report and return any dollars that the provider should not have received. In order to aid providers in this process, on August 6th, 2014 the Office of the Medicaid Inspector General (OMIG) hosted a webinar that shows Medicaid providers in New York how to self disclose. Self disclosure efforts by OMIG and providers yielded over $20 million in returned payments during OMIG's last reporting year. OMIG suggests that every Medicaid provider view Webinar #21 - Self Disclosure to understand how the process works, and what they can do as a provider to comply with this important requirement.

Nassau Doctor Denied Medicaid Reinstatement

A Nassau County physician, Mark Shaffer, was denied reinstatement into the New York State Medicaid program following an evaluation of his application by the New York State Office of the Medicaid Inspector General. This denial was based on concerns about his past behavior which had included failure to maintain patient records, allowing unqualified staff to administer inoculations, and filing false reports with the aim of inflating insurance reimbursements.

Shaffer has been excluded from participation in the Medicaid program since 2007 and recently applied for reinstatement. The exclusion was based on a consent order he signed with the New York State Board of Professional Medical Conduct in which he “agreed not to contest” charges of negligence on more than one occasion.

As the result of the signed consent order, his medical license was suspended for one year, with active suspension for the first three months and the final nine months stayed. He was then placed on probation for 36 months and required to practice under the supervision of another physician throughout the 36-month period.

After a full review of the facts supplied to the agency with his re-application materials, OMIG issued the denial for reinstatement into Medicaid. OMIG made this determination via authority under the regulations guiding the agency. Following OMIG’s determination, Shaffer will remain on the Exclusion/Termination list. Providers must make a formal application to be considered for removal from this list. Shaffer must wait at least two years from the date of the denial letter before submitting another application for reinstatement to the Medicaid program.

Details of the process are available on the OMIG Web site, including the ability to check the Exclusion/Termination list for additional names.

Chemical Dependence Service Provider Guidance Published

OMIG published Compliance Guidance 2014 - 04 Revision # 1. This compliance guidance gives information relevant to inpatient chemical dependency rehabilitation and outpatient chemical dependency services providers. This document is part of a series of guidance documents that can be seen here.

Ambulette company overbilled Medicaid by more than $2.48 million

Reliance Ambulette, a Flushing, New York -based provider of medical transportation services, overbilled the Medicaid program by $2,487,129 during a two-year period, according to a recent audit (#08-1781) completed by the New York State Office of the Medicaid Inspector General (OMIG) in conjunction with the New York City Human Resources Administration. The audit cites the company for lack of compliance with standards required by the Medicaid program. The audit was conducted under the auspices of the County Demonstration Program, a joint state and local partnership, overseen by OMIG.

Reliance was cited for several issues. These included:

  • failure to ensure that all drivers were duly licensed by the New York City Taxi and Limousine Commission (T&LC) and 19-A certified by the New York State Department of Motor Vehicles
  • failure to prepare and maintain contemporaneous records demonstrating its right to receive payment, and
  • missing or inaccurate information on the Medicaid claims submitted for payment.

The audit can be seen here.