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New York Office of the Medicaid Inspector General (“OMIG”): New 2024 Developments

OMIG started off 2024 by releasing its 2024 Work Plan, which is noteworthy as the last plan that is available on OMIG’s website was released for the 2019 – 2020 period.  The specific Work Plan can be reviewed in its entirety at the following site:

 

 

This Work Plan outlines OMIG’s forthcoming initiatives, including the following:

 

(1)  Compliance Program Reviews – Such reviews will include providers and Medicaid Managed Care Organizations to ensure in part that they have updated compliance programs based on the compliance plan regulatory changes which took effect in 2023.

 

(2)  Medicaid Managed Care Audits and Provider Audits – On the provider side, nursing homes and assisted living programs remain targeted providers and OMIG intends to review services to ensure they are rendered accurately and documented based on applicable Medicaid requirements.  OMIG will engage in 2024 in Nursing Home Rate Audits as well as Minimum Data Set Reviews.

 

(3)  Pharmacy – OMIG intends to focus on pharmacies in order to ensure, for example, that necessary authorizations are in place for the payment for controlled substance claims.

 

In addition to its Work Plan, on January 19, 2024, OMIG released updates to its Self-Disclosure Guidance and its Self-Disclosure Frequently Asked Questions.  Here is a link to the updates:

 

 

As with other guidance materials from OMIG, these materials should be incorporated into existing compliance programs, especially with OMIG announcing its 2024 Compliance Program Reviews as noted above.


 

Our firm has extensive experience counseling health care providers on statutory and regulatory requirements, as well as preparing and implementing applicable policies. If you have any questions related to this Legal Briefing, please contact any member of our firm at 585-730- 4773.



New York Office of the Medicaid Inspector
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This Legal Briefing is intended for general informational and educational purposes only and should not be considered legal advice or counsel. The substance of this Legal Briefing is not intended to cover all legal issues or developments regarding the matter. Please consult with an attorney to ascertain how these new developments may relate to you or your business. © 2024 Law Offices of Pullano & Farrow PLLC

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