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New York State Office of the

Medicaid Inspector General


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


Archived Webinars

OMIG Webinar #1: Addressing Excluded Persons in Medicaid Employment, Ordering and Contracting

Description: The New York State Office of the Medicaid Inspector General presented the first in a series of OMIG Webinars on June 8, 2010. Entitled "Addressing Excluded Persons in Medicaid Employment and Contracting--New York," this session covers New York State and federal laws governing exclusion and provides examples of several cases in which exclusion from the Medicaid program has been applied to individuals.

OMIG Webinar #2: Mandatory Reporting of Medicaid Overpayments Under the Obama Health Program

Description: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA).Under Section 6402 of PPACA, and "person" who has received (either directly or indirectly) an overpayment from the Medicaid program is obligated to "report and return" the overpayment to the state, and to provide an explanation "in writing of the reasons for the overpayment, within 60 days of identification of the overpayment." Failure to do so may expose the "person" to liability under the False Claims Act, including whistleblower actions, treble damages and penalties.

This OMIG Webinar will review the responsibilities of both "persons" and Medicaid providers under this statute, which took effect March 23, 2010. OMIG will begin its audit and enforcement activities under PPACA on January 1, 2011, and this Webinar is designed to provide education and guidance in complying with this significant new obligation.

OMIG will also be soliciting questions from Webinar participants about application and compliance with these requirements in New York Medicaid, in order to develop and respond to frequently asked questions on the OMIG Web site.

OMIG Webinar #4: Provider and Third-Party Payer Obligations: Medicaid Third-Party Billing, Payment and Enforcement

Description: OMIG's next webinar, Provider and Third-Party Payer Obligations: Medicaid Third-Party Billing, Payment and Enforcement, is scheduled for October 20th at 2PM Eastren. The session will discuss the responsibility of health care providers under the third-party liability laws, the effect of Section 6402 of the Patient Protection and Affordable Care Act (PPACA, or the Obama health plan) on providers' and payers' third-party responsibilities and how we "ensure that the medical assistance program is the payer of last resort."

OMIG Webinar #5 - Evaluating Effectiveness of Compliance Programs

Description: The next Webinar for the Office of the Medicaid Inspector General, "Evaluating Effectiveness of Compliance Programs," will take place on Wednesday, November 17, 2010 at 2 pm. Featured speakers will be Medicaid Inspector General James G. Sheehan, Assistant Deputy Medicaid Inspector General for Compliance Matthew Babcock, and Compliance Specialist Carol Booth.

OMIG Webinar #6 - Ten compliance questions for health care providers and outside billing entities about the use of outside billers to the New York Medicaid program.

Description: New York Medicaid requires that all "persons submitting claims, verifying client eligibility, or obtaining service authorizations for or on behalf of providers" must be enrolled separately in the Medicaid program as a "service bureau" unless the person is an employee of the provider. 18 NYCRR 504.9. In addition, "any provider which "submit (s) claims, verifies client eligibility, or obtain(s) service authorizations for or on behalf of any other entity must enroll as a service bureau in addition to enrolling as a provider of medical care, services, or supplies."

These provisions allow the Medicaid program to identify and address each of the responsible entities when improper billing is discovered, and help assure that an effective compliance program is in place and properly certified for both the health care provider and the billing/verifying entity.

Recent OMIG reviews, and MFCU investigations have identified significant failures of compliance by both third party billing and third party client eligibility entities, and by the health care providers which contract with those entities.

Tracking and monitoring third party entities involved in billing has acquired greater significance with the advent of widespread electronic claim submission and the use of claims consolidators and clearinghouses. The Affordable Care Act, Section 6503, requires that "billing agents, clearinghouses, or other alternate payees that submit Medicaid claims on behalf of health care provider must register with the State and Secretary in a form and manner specified by Secretary, " although the implementing regulations have not yet been issued. New Jersey requires that billing services be enrolled with the Department of Banking and Insurance. N.J.S.A. 17B:27B-1 et seq.

OMIG Webinar #7 - How Effective Compliance Programs Address Whistleblower Issues

Description: The Law and Policy of Health Care Whistleblowers under False Claims Act (FCA), Fraud Enforcement and Recovery Act (FERA), Affordable Care Act (ACA), and New York Law

Federal and state law have greatly expanded the protections given whistleblowers under the False Claims Acts and related statutes, and have imposed greater obligations and risks on employers and contractors.

This presentation will review governing law, and suggest approaches which can demonstrate compliance program effectiveness and address your organization's risks in addressing whistleblower cases.

OMIG Webinar #8 - Program Obligations for New York State Early Intervention Program Providers and Municipalities

Description: The Office of the Medicaid Inspector General and the Department of Health's Bureau of Early Intervention will present a joint Webinar on Wednesday, March 30, 2011, at 1 pm, entitled:

"Program Obligations for New York State Early Intervention Program Providers and Municipalities: Addressing Excluded Persons, Following Reporting Requirements under the Affordable Care Act, and More."

Speakers will be James Sheehan, Medicaid Inspector General, and Bradley Hutton, Director of DOH's Bureau of Early Intervention.

OMIG Webinar #9 - New York State Pre-School/School Supportive Program:Medicaid Compliance

Description: Schools in New York State are required to provide supportive services (e.g., physical, occupational, speech and psychological counseling therapies) to students, some of which are financed through the Medicaid program. School districts are not traditional Medicaid providers, however, so what type of billing and claiming guidance should they rely upon to ensure that they follow New York's Medicaid regulations? What role do outside billing companies play in submitting materials for reimbursement for school districts? How do these questions impact on the actual provision of services to students who are eligible to receive them?

These are examples of some of the questions to be addressed during a Webinar to be held on Wednesday, April 27, 2011, from 1-2:30 pm, co-presented by the New York State Office of the Medicaid Inspector General, the New York State Department of Health and the New York State Department of Education. This important collaborative educational session will focus on Medicaid regulations, OMIG provider exclusions and how such administrative actions can have an impact on a school's hiring practices, third-party billing issues, billing and claiming guidance available to school districts, and more.

OMIG Webinar #10 - Responding to Medicaid Inspector General Audits and Compliance Reviews of Home Health and Personal Care Services: The Law, Regulation, and Process of Medicaid Audits

Description: This seminar will address audits by the Office of the Medicaid Inspector General (OMIG) of home health, personal care, consumer-directed care, and housekeeping services, with special focus on OMIG's use of automated conflict and exception reports for targeting and for determining what services were actually rendered to beneficiaries.

The speakers will also discuss the Medicaid reinvention team mandate for conflict and exception reports for providers receiving in excess of $15 million annually, and plans for implementation.