Medicaid Managed Care Program Integrity Reviews


As part of the 2019-2020 New York State Budget, the Office of the Medicaid Inspector General (OMIG) will commence reviews of managed care organizations (MCOs) to evaluate compliance with program integrity sections of the Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan Contract (Contract). These reviews are authorized by Social Services Law Section 364-j (36) and 18 New York Codes Rules and Regulations Part 517.  

Newly enacted Social Services Law section 364-j(36)(b) requires that OMIG publish on its website a list of contractual obligations subject to review. The Matrix of Contract Obligations and Performance Standards identifies the contract sections OMIG will review and how performance shall be measured.

MCOs identified for review will receive from OMIG an Audit Notification Letter, which details the review process, timeframe, document submission instructions, and OMIG contact information.

Questions regarding OMIG’s Medicaid Managed Care Program Integrity Reviews should be emailed to: [email protected].