New York Medicaid Integrity Plan

The New York State Office of the Medicaid Inspector General issued its SFY '09 audit work plan on April 22. This is the first annual audit work plan of new IG office created by the State of New York in order to address concerns raised by earlier USDHHS OIG audits. The new Medicaid IG plans to review hospitals, nursing facilities, home health agencies, managed care organizations, adult day health providers, substance abuse treatment programs, pharmacies, and providers of durable medical equipment. Auditors will focus on improper billing practices such as upcoding, lack of authorization for billed services, and duplicate billing for services covered under capitated rates. The OMIG also plans to conduct data mining to identify trends indicative of potential fraud and abuse.

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).