New York State Medicaid and the Medicaid Inspector General

Medicaid is a program for New York State residents that provides medical care. Medicaid consumers are very important to the New York State Office of the Medicaid Inspector General (OMIG). OMIG's job is to protect consumers and the resources of the Medicaid program. OMIG efforts saved taxpayers like you more than $2 Billion dollars and recovered more than $879 Million in 2013. OMIG wants to hear from you:

One way that OMIG works with consumers to fight fraud is through the use of Explanation of Medicaid Benefit (EOMB) notices. These notices are sent to Medicaid consumers to check to see if services that were billed were actually provided. We encourage people who recieve the notices to review them and then report back on whether services were provided. We are posting this EOMB to make sure that Medicaid consumers know what an EOMB is and why they are getting one.

Read below to learn more about how consumers can help fight fraud and abuse in the Medicaid program.

Examples of Fraud or Abuse by Health Care Providers
Examples of Fraud or Abuse by Other Consumers
  • Billing for Medicaid services when you did not get all the services you were supposed to get
  • Giving out or selling prescriptions when you do not need them
  • ordering tests that you do not need
  • Giving money or presents to consumers in return for agreeing to get medical care from someone

  • Getting medical help that is not needed
  • Getting paid by a doctor for recieving medical services
  • Using someone else's Medicaid card
  • Forging a prescription
  • Receiving Medicaid when you are ineligible
Determining Whether You Are Qualified for Medicaid or Another Program

Information about the Medicaid program and benefits are available on the Web site of the New York State Department of Health (DOH), under Medicaid. This includes information concerning how to apply for Medicaid, income limits for Medicaid eligibility, downloading application materials, and other useful guidelines. Consumers can also use the numbers below.

For more details, use the ACCESS NY Public Health Insurance Eligibility Screening Tool to see which public health insurance programs you and your family may be eligible for.

  • Consumer Medicaid Helpline 1-800-541-2831
  • New York Medicaid Choice 1-800-505-5678 or click here

As a reminder, income levels are an important test for whether someone is Medicaid eligible. Individuals should periodically assess their income to ensure that they are still eligible for Medicaid.

Medicaid is not the only state health program. Three other health programs help connect many New Yorkers with access to healthcare. These programs are:

Finding Other Resources
Learning More From the Federal Government

As the United States gradually incorporates regulations associated with the Patient Protection and Affordable Care Act (ACA) of 2010, consumers may seek information about the latest changes in federal statutes and news associated with ACA. The following links from the Centers for Medicare and Medicaid Studies may be useful.

Connecting with OMIG

Health care professionals are on the frontlines in fighting fraud. We want to make sure we keep in touch. Here's some ways you can: