Compliance/Enforcement - Responding to OMIG Audits

Since it was created by law in 2006, the New York Office of the Medicaid Inspector General has aggressively pursued recoupment of Medicaid payments from providers and health plans. Given the astronomical estimates of improper payments related to waste, fraud and abuse in the New York Medicaid program, and the escalating recovery targets imposed upon OMIG by the New York State Legislature and the Federal-State Health Reform Partnership (F-SHRP), OMIG audit activity will increase and can be expected to impact virtually every Medicaid provider and health plan in New York.

Hinman Straub's fraud and abuse group has extensive experience in representing clients undergoing an OMIG audit. We work directly with chief compliance officers, clinical personnel, billing specialists and internal counsel throughout all phases of an OMIG audit, from preparing a response to data requests, to providing advocacy during the audit phase, the draft audit report phase, and the final audit report phase and, ultimately, to negotiating settlements and, if necessary and appropriate, prosecuting an appeal. Our in depth knowledge of all aspects of the New York Medicaid program’s underlying statutory, regulatory and administrative policies enables us to assure that our clients are treated fairly and not subjected to unreasonable or excessive recoupments.

In addition to formulating audit strategies tailored to each client's unique circumstances, we recognize that many issues raised during an individual OMIG audit implicate overriding policy and/or industry-wide practices that may be best addressed through a coordinated strategy with other providers, trade associations, and legislative or administrative agency policymakers. Hinman Straub has well-established relationships with these key stakeholders and can assist clients in developing and implementing coordinated approaches to maximize an audit defense.

Practice Area Professionals

Sean Doolan

Mara Ginsberg

Raymond Kolarsey

Philip Murphy

Stephanie Piel

Jennie Shufelt

To learn more about our Health services, please contact Raymond Kolarsey.