Report Details the Final Tally of Medicaid Recoveries and Cost Savings That Were Released Earlier This Year
Avoiding Unnecessary Costs to the Medicaid Program Saved Taxpayers More Than $2 Billion
$879 Million in Medicaid Overpayments Recovered in 2013 and $1.73 Billion Over Last Three Years
Albany, NY (Oct. 9, 2014) - The New York State Office of the Medicaid Inspector General (OMIG) today released its 2013 Annual Report. Representing the final totals for Medicaid recoveries and cost savings in 2013, the report shows that OMIG's efforts saved taxpayers more than $2 billion and generated a record $879 million in recoveries last year. Over the last three years, Medicaid recoveries exceeded $1.73 billion, which represents a 34-percent increase over the prior three-year period.
“Ensuring the integrity of the state's Medicaid program is an essential component of Governor Cuomo's ongoing, successful initiative to enhance the quality of care in the state's health care delivery system while continuing to reduce costs,” Medicaid Inspector General James C. Cox said. “These record-setting recoveries and billions in cost savings play a major role in protecting the integrity of the state's Medicaid program and ensuring New Yorkers have access to high-quality services.”
These results and other achievements are detailed in OMIG's 2013 Annual Report, which is available on the OMIG website at: http://www.omig.ny.gov/images/stories/annual_report/2013_annual_report.pdf
Highlights from the 2013 Annual Report include:
OMIG identified more than $226 million through audit activities, which included record-breaking years in the areas of fee-for-service and managed care audits, with $104 million and $47 million identified for recovery, respectively. Additionally, more than $16 million was self-disclosed by providers, more than $7.2 million was identified through the work of the County Demonstration program, and more than $7 million resulted from data mining initiatives.
- Through its array of program initiatives, including pre-payment reviews and corporate integrity agreement (CIA) monitoring, OMIG avoided more than $2 billion in unnecessary costs to the Medicaid program. These cost-savings measures have generated a three-year estimated total of $7.06 billion, a nearly $2 billion increase over the previous three years.
- CIA monitoring and enforcement efforts alone resulted in more than $55 million of these avoided costs to the Medicaid program. CIAs are offered by OMIG to providers with a history of program integrity issues as an alternative to exclusion from the Medicaid program, when exclusion might lead to extenuating circumstances such as service shortages within a given geographical area.
- To prevent inappropriate expenditures of Medicaid funds, OMIG and the New York State Attorney General's Medicaid Fraud Control Unit pursued credible allegations of fraud under the federal Affordable Care Act, which resulted in the suspension of approximately $46 million in payments to providers.
- In 2013, OMIG ended Medicaid program participation for more than 702 providers. As a result of OMIG's efforts, these providers can no longer work in Medicaid-funded positions in health care-oriented businesses and organizations, or submit claims to the Medicaid program. Additionally, OMIG referred 164 providers to the Medicaid Fraud Control Unit for potential criminal prosecution.
- OMIG's investigative unit identified more than $6.7 million, as a result of OMIG's collaborative work with several law enforcement partners, which represents the highest total in five years.
New Yorkers can assist the Office of the Medicaid Inspector General in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents. OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG's fraud hotline at 1-877-87-FRAUD or visit the OMIG website at www.omig.ny.gov Tips can be completely anonymous, and OMIG investigates information from all calls received.
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.
You can help stop Medicaid fraud: Call OMIG’s Fraud Hotline at 1-877-87 FRAUD (1-877-873-7283), or click here to file a complaint electronically.
The OMIG may sanction some providers by excluding them from participating in the Medicaid program. These providers are excluded from offering services to Medicaid enrollees and also cannot be paid with Medicaid dollars. Prior to adding new staff members, employers should check to see if prospective employees have been excluded from Medicaid. To make it easier to perform such a check, OMIG set up a dedicated service to check the status of any exclusion.
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Anytime a health care organization discovers that it was paid more than it was due, this should be reported to OMIG. Our Self-Disclosure section provides information for health care organizations to complete the recently revamped self-disclosure process.
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