The Office of the Medicaid Inspector General (OMIG) conducts reviews of managed care organizations (MCOs) to evaluate the MCO’s compliance with program integrity sections of the respective Model Contract (Contract). These reviews are authorized by Social Services Law Section 364-j (36) and 18 New York Codes Rules and Regulations Part 517.
Social Services Law section 364-j(36)(b) requires that OMIG publish on its website a list of the contractual obligations subject to review. The Matrix of Contract Obligations and Performance Standards identifies the contract sections OMIG will review, the performance standards and how performance shall be measured.
MCOs identified for review will receive from OMIG an Audit Notification Letter which details the review process, timeframe, and document submission instructions, as well as provides OMIG contact information. The MCO will also receive the Medicaid Managed Care Program Integrity Review Module (Review Module). The Review Module outlines each contractual obligation under review with questions, information and document requests related to each contractual obligation. A desk review will commence, the MCO will be provided with a report of OMIG’s findings and be given the opportunity to respond.
Questions regarding OMIG’s Medicaid Managed Care Program Integrity Reviews should be emailed to: [email protected]
