Fighting Fraud and Abuse Saves Billions of Taxpayer Dollars
Notable OMIG Actions
The New York State Office of the Medicaid Inspector General (OMIG) fights fraud in the Medicaid program. Through its efforts, in 2013 OMIG: Medicaid is a federal/state healthcare system that provides vital service to people who need them. OMIG is an independent entity that reviews the Medicaid program to fight fraud as well as detect and prevent wasteful and abusive practices. OMIG employs the latest state-of-the-art techniques to review services and payments made under the Medicaid program. OMIG promotes high quality patient care and recovers dollars that should not have been spent.

Helping to Fight Fraud in the Medicaid Program

Medicaid fraud, waste, and abuse take many forms and can originate with a provider or a consumer of Medicaid services. Medicaid providers include physicians, dentists, hospitals, nursing homes, adult day health care providers, assisted living providers, clinics, pharmacies, ambulance and medical transportation companies, medical equipment vendors, and anyone else who receives payment from Medicaid for a healthcare-related service.

Many taxpayers receive healthcare services or know someone who receives Medicaid funded services or goods. Other taxpayers want to help ensure that healthcare dollars are preserved. In either case, OMIG wants to hear from you.

Taxpayers can contact the Medicaid Fraud Hotline by calling 1-877-87 FRAUD (1-877-873-7283) or by by clicking under the Fraud tab above and selecting "File an Allegation."

Examples of fraud may include (but are certainly not limited to these):

  • Billing for unnecessary services – Ordering and then subsequently charging the Medicaid program for services a patient does not need;
  • "Phantom" billing – Billing Medicaid for services or for dispensing products that the patient never received, such as patient visits that never took place, dental fillings for teeth that had previously been extracted, medical equipment that was never delivered;
  • Multiple billing – Intentionally sending bills to Medicaid for the same procedure or office visit more than once;
  • Upcoding – Intentionally billing Medicaid for a more expensive treatment or medication than the one the patient actually received;
  • Kickbacks – When Medicaid providers such as physicians, hospitals, dentists, clinics, etc., give money, items of value, or other considerations to other healthcare providers in exchange for referrals or for business; and
  • Selling drugs/forging or altering prescriptions – When a Medicaid patient fills a legitimately authorized prescription, written by an authorized physician, and then sells the contents for profit, that is fraud. Altering the amount of a prescription, or stealing and using a prescription pad from a doctor is fraud.
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:

Reviews of OMIG Efforts By Outside Entities

As an agency that audits and reviews the activities of Medicaid providers, OMIG's work is reviewed by external entities. Listed below are recent reviews: