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Medicaid Inspector General, Office of the
Functions
The Office of Medicaid Inspector General is responsible for prevention, detection, and investigation of fraud and abuse within the medical assistance program; referral of appropriate cases for criminal prosecution; and recovery of improperly expended medical assistance funds. The office is also charged with prioritizing and focusing fraud, waste, and abuse control activities; creating a single point of leadership of and responsibility for such activities; building and maintaining an integrated system of communication among all involved agencies with fraud, waste, and abuse control responsibilities; and maximizing the use of all available state resources for such activities.
When abuse is discovered, the office is empowered to pursue civil and administrative enforcement actions against any individual or entity that engages in fraud, abuse, illegal or inappropriate acts, or unacceptable practices perpetrated within the medical assistance program. The office makes information and evidence relating to suspected criminal acts available to appropriate law enforcement officials. The Medicaid Inspector General works closely with the Attorney General's Medicaid Fraud and Control Unit (MFCU) and seeks to strengthen partnerships with federal and local law enforcement agencies.
History
The Office of Medicaid Inspector General (OMIG) was initially established in 2005 by Executive order 140.1 and then established by statute (L. 2006 Ch. 442) as an independent entity within the New York State Department of Health to create a more efficient and accountable structure, dramatically reorganize and streamline the state's process of detecting and combating Medicaid fraud and abuse, and maximize the recoupment of improper Medicaid payments. The new office consolidated the resources and Medicaid fraud detection, prevention, and recovery responsibilities of multiple governmental entities into a single office.
The office's mandate was to improve and preserve the integrity of the Medicaid program by conducting and coordinating fraud, waste, and abuse control activities for all state agencies responsible for services funded by Medicaid. The office conducts and supervises all prevention, detection, audit and investigation efforts and coordinates such activities with the Department of Health, Office of Mental Health, Office for People With Developmental Disabilities, Office of Addiction Services and Supports, Office of Temporary Disability Assistance, Office of Children and Family Services, Commission on Quality of Care and Advocacy for Persons with Disabilities, and the State Education Department.
Legal Citations
L. 2006, Ch. 442.
