Statement in Response to OMIG Comments on Reform Legislation

By Providers Associations | April 2, 2024

In the March 29 Politico article “The Battle Over Medicaid Audits,” an Office of the Medicaid Inspector General spokesperson stated that proposed reforms to punitive auditing practices would “modify the OMIG’s ability to enforce such standards” and that audit recoveries are not penalties or fines and instead, the audits “only ask providers to return any money paid inappropriately” as is required under regulation and state and federal law.

If this were true, 50-plus provider associations and a bipartisan coalition of lawmakers would not be seeking reform.

First, the bill is clear that in no way does it limit OMIG’s ability to identify and address cases of actual fraud or abuse in the Medicaid program. Further, the bill clearly defines ‘overpayments’ consistent with the definition in federal law as an amount paid in excess of what is allowable and enables the recovery of such claims by OMIG. The bill continues to allow for the use of extrapolation of overpayments consistent with how the federal Centers for Medicare and Medicaid Services (CMS) utilizes it. Finally, the bill clearly defines administrative and technical errors consistent with federal rules, which are in no way overpayments and have no bearing on the quality of or the validity of the service provided. Providers would be permitted to correct and resubmit claims for technical errors that meet standards outlined in the bill.

Contrary to OMIG’s claims, federal and state auditing laws do not require the highly punitive auditing practices used by OMIG for administrative and technical errors. These tactics are inconsistent with Governor Hochul’s prioritization of support and investments in mental health, reproductive health and care provided by the state’s safety net providers. We seek Governor Hochul’s support for enacting the urgent reforms being pursued by the Legislature in the final State Budget to protect access to essential health and mental hygiene services for New Yorkers with Medicaid.

A letter was sent to Governor Hochul and the entire State Legislature on March 27, 2024 urging enactment of OMIG audit reform legislation (S5329D/A6813B) as part of the SFY 2025 State Budget which can be found here.