The Office of the Medicaid Inspector General (OMIG) is a part of the NYS Dept. of Health that was created to ensure compliance with Medicaid laws and regulations.

The OMIG educates, coordinates, and investigates the State’s agencies, providers, and managed care entities about state law concerning Medicaid claims and payments. In the event that fraud or abuse is expected, it prosecutes and obtains repayment of wrongfully paid federal funds.

In furtherance of its mission to prevent fraud, waste, and abuse, the OMIG educates state agencies, providers, and managed care entities about proper Medicaid practices by developing educational training materials and programs. It trains all medical service providers on self-investigation techniques so that they may learn to self-identify areas of potential noncompliance or abuse. Toward that end, the OMIG has developed a compliance program that all agencies or individuals providing services funded by Medicaid must employ if they wish to continue to provide Medicaid services.

The OMIG responds to and examines allegations that an agency did not attempt to prevent, to detect, or to prosecute suspected Medicaid fraud. It investigates allegations of actual fraud or abuse perpetrated by any individual or agency against a medical assistance program, a provider, a managed care program or an individual.

The OMIG conducts on-site facility and office inspections for evidence of abuse. In the course of its investigations, it has the right to remove documents, subpoena or demand records, and compel testimony.

If the OMIG has evidence of fraud or abuse, it may pursue civil and administrative enforcement actions against accused individuals or entities. Under the NYS law, the OMIG has the authority to pursue a variety of actions. It many do any or all of the following: refer an action to regulator agencies and licensing boards; withhold the payment of funds; impose administrative sanctions and penalties; exclude providers from program participation; recover improperly paid funds including seizing property or assets connected to improper payments; and refer suspected criminal activities to the Attorney General’s Medicaid Fraud Control Unit.

Possible criminal penalties applied to those found guilty of Medicaid fraud include full repayment of wasted Medicaid money, a fine of up to $500,000 and up to 10 years of jail time. Besides, an unethical healthcare provider can be barred from ever taking part in Medicaid. What is more, Medicaid fraud charges frequently go with other crimes, like identity theft or insurance fraud, which can significantly build up criminal charges applied to the person.

In case you find yourself under audit or investigation, you should follow these steps:

NYC Medicaid fraud attorneys from Norman Spencer Law Group will handle all interaction between the investigated person or entity and OMIG officials. They will guide the client through all stages of New York State OMIG audit and, if necessary, help them in Medicaid fraud criminal prosecution. Armed with decades of experience, our Medicaid fraud lawyers will do their best to reach a satisfying result.

We have handled over 100 OMIG investigations and audits. Here are just a few examples.