Medicaid Inspector General, Office of the

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Agency Web Site: https://omig.ny.gov/Link to External Website

Mission

The Office of the Medicaid Inspector General (OMIG) preserves 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 the Medicaid program. In fulfilling this role, the Office conducts and supervises all prevention, detection, and investigation activities and makes recommendations to these agencies for improvement. In addition, the Medicaid Inspector General works closely with the Attorney General’s Medicaid Fraud and Control Unit (MFCU) and Federal and local law enforcement officials.

Organization and Staffing

OMIG is headed by the Medicaid Inspector General, who is appointed by the Governor. The agency is organized into seven major business units: The Executive Office, Division of Medicaid Audit, Division of Medicaid Investigations, Division of System Utilization and Review, Division of Administration, and Office of Counsel.

Budget Highlights

The Executive Budget recommends funding of $47 million, a decrease of $1.5 million from the FY 2021 Enacted Budget. OMIG's budget has effectively remain flat as there was an additional 27th pay period in FY 2021.

The Budget recommends a workforce of 515 full time equivalent employees (FTEs) and continues to support an increase of 35 FTEs as part of a workforce investment made in the FY 2021 Enacted Budget to support enhanced program integrity efforts. Funding for this workforce investment is financed through increased audit recoveries and cost avoidance.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Program Highlights

Medicaid Audit

OMIG staff conduct audits and reviews of Medicaid providers to determine compliance with program requirements and to identify improper Medicaid payments. Staff has knowledge about various types of medical and clinical providers and has audit experience in a broad range of health care programs. This affords OMIG the opportunity to develop, coordinate, and implement a broad spectrum of statewide Medicaid projects.

Medicaid Investigations

OMIG staff continuously monitor the Medicaid program for evidence of fraud and abuse. Staff respond to detected fraud, impose sufficient punishment to deter others, and promptly remedy program vulnerabilities. Additionally, staff conduct investigations of providers furnishing dental, mental, medical care, and support services which include prescriptions, transportation, personal assistance, counseling, and complete care in nursing home or hospital settings. Investigations are also conducted of Medicaid recipients who abuse and/or defraud the Medicaid system by submitting false application information to qualify for benefits, drug diversion, and card loaning.

ALL FUNDS
APPROPRIATIONS
(dollars)
Category Available
FY 2021
Appropriations
Recommended
FY 2022
Change From
FY 2021
Reappropriations
Recommended
FY 2022
State Operations 52,613,000 55,244,000 2,631,000 30,595,000
Total 52,613,000 55,244,000 2,631,000 30,595,000

ALL FUND TYPES
PROJECTED LEVELS OF EMPLOYMENT BY PROGRAM
FILLED ANNUAL SALARIED POSITIONS
Program FY 2021
Estimated FTEs
03/31/21
FY 2022
Estimated FTEs
03/31/22
FTE Change
Medicaid Audit and Fraud Prevention
General Fund 223 258 35
Special Revenue Funds - Federal 222 257 35
Total 445 515 70

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY FUND TYPE
APPROPRIATIONS
(dollars)
Fund Type Available
FY 2021
Recommended
FY 2022
Change
General Fund 20,722,000 21,758,000 1,036,000
Special Revenue Funds - Federal 31,891,000 33,486,000 1,595,000
Total 52,613,000 55,244,000 2,631,000
Adjustments:
Transfer(s) From
Health, Department of
General Fund (1,296,000)
Special Revenue Funds - Federal (1,296,000)
Appropriated FY 2021 50,021,000

STATE OPERATIONS
ALL FUNDS FINANCIAL REQUIREMENTS BY PROGRAM
APPROPRIATIONS
(dollars)
Program Available
FY 2021
Recommended
FY 2022
Change
Medicaid Audit and Fraud Prevention
General Fund 20,722,000 21,758,000 1,036,000
Special Revenue Funds - Federal 31,891,000 33,486,000 1,595,000
Total 52,613,000 55,244,000 2,631,000

STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED
(dollars)
Program Total Personal Service Regular
(Annual Salaried)
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 17,880,000 851,000 17,857,000 931,000
Total 17,880,000 851,000 17,857,000 931,000
STATE OPERATIONS - GENERAL FUND
SUMMARY OF PERSONAL SERVICE APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED CONTINUED
(dollars)
Program Temporary Service
(Nonannual Salaried)
Holiday/Overtime Pay
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 13,000 (15,000) 10,000 (65,000)
Total 13,000 (15,000) 10,000 (65,000)

STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED
(dollars)
Program Total Supplies and Materials
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 3,878,000 185,000 125,000 (230,000)
Total 3,878,000 185,000 125,000 (230,000)
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED CONTINUED
(dollars)
Program Travel Contractual Services
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 120,000 (100,000) 3,556,000 638,000
Total 120,000 (100,000) 3,556,000 638,000
STATE OPERATIONS - GENERAL FUND
SUMMARY OF NONPERSONAL SERVICE AND MAINTENANCE UNDISTRIBUTED
APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED CONTINUED
(dollars)
Program Equipment
Amount Change
Medicaid Audit and Fraud Prevention 77,000 (123,000)
Total 77,000 (123,000)

STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED
(dollars)
Program Total Personal Service
Amount Change Amount Change
Medicaid Audit and Fraud Prevention 33,486,000 1,595,000 17,880,000 851,000
Total 33,486,000 1,595,000 17,880,000 851,000
STATE OPERATIONS - OTHER THAN GENERAL FUND
SUMMARY OF APPROPRIATIONS AND CHANGES
FY 2022 RECOMMENDED CONTINUED
(dollars)
Program Nonpersonal Service
Amount Change
Medicaid Audit and Fraud Prevention 15,606,000 744,000
Total 15,606,000 744,000

Note: Most recent estimates as of 01/19/2021