New York OMIG Saves $2B, Recovers $879M in Medicaid Spending
- Last week, New York State’s Office of the Medicaid Inspector General (OMIG) released its 2013 annual report that focuses on spending and fraud prevention. It includes the final totals for Medicaid recoveries and cost savings during the year. The numbers show that the OMIG saved taxpayers more than $2 billion and generated a record $879 million in recoveries in 2013. The Medicaid program covers 5.3 million of New York’s 19 million residents.
Looking deeper into the findings, Medicaid overpayments recovered $1.73 billion over the last three years. That represents a 34-percent increase over the previous three-year period.
“Ensuring the integrity of the state’s Medicaid program is an essential component of [New York} Governor [Andrew] 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 Cox said in the report. “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.”
Medicaid recovery efforts
Through audit activities, OMIG identified more than $226 million for recovery. Fee-for-services and managed care audits produced record-breaking years, uncovering $104 million and $47 million for recovery respectively. On top of that, more than $16 million was self-disclosed by providers, more than $7.2 million was identified through the County Demonstration program and more than $7 million resulted in data mining initiatives.
The OMIG and the New York State Attorney General’s Medicaid Fraud Control Unit, pursued credible allegations of fraud under the Affordable Care Act. This resulted in the suspension of nearly $46 million in payments to providers. OMIG’s investigative unit, with the help of several law enforcement partners, also discovered more than $6.7 million in inappropriate expenditures. This is the highest total in five years.
All of this inappropriate spending caused OMIG to end Medicaid program participation for more than 702 providers. As a result, these providers can no longer work in Medicaid-funded positions in health care-oriented businesses and organizations, or submit claims to the program. An additional 164 providers were passed along to the Medicaid Fraud Control Unit for potential criminal prosecution.
Cost saving practices
The $2 billion in unnecessary costs to the Medicaid program was overcovered through an array of program initiatives. These include pre-payment reviews and monitoring of any corporate integrity agreements. The three-year estimated total cost-savings is $7.06 billion, nearly $2 billion more than the previous three years.
Corporate integrity agreement monitoring and enforcement alone resulted in more than $55 million in avoided costs to the Medicaid program. This process is used for providers that have a history of integrity issues to prevent them from being excluded from Medicaid.
“In this, my third year as Medicaid Inspector General, I am very proud of the collaborative work being done in this agency, not only internally but with providers, managed care plans, beneficiaries, policymakers, and law enforcement partners,” Cox wrote.
