STATE MEDICAID INSPECTOR GENERAL ANNOUNCES NEARLY $3.4 BILLION SAVED AND RECOVERED IN NEW YORK’S MEDICAID PROGRAM IN 2022

Acting Medicaid Inspector General Frank Walsh today announced nearly $3.4 billion in savings and recoveries through the State’s Medicaid program integrity efforts in 2022. Medicaid recoveries - which are generated through provider audits and investigations - accounted for nearly $819 million in savings. Cost-avoidance efforts, upfront measures that prevent inappropriate and unnecessary costs to the Medicaid program, delivered more than $2.6 billion in savings. Over the last four years, combined Medicaid recoveries and cost-savings efforts exceeded $11.8 billion. New York’s impressive cost-savings and recovery results and comprehensive Medicaid program integrity efforts are detailed in the New York State Office of the Medicaid Inspector General (OMIG) 2022 Annual Report. 

Medicaid program integrity highlights in 2022 include: 

• Cost-avoidance measures, including prepayment reviews of claims and pre-payment insurance verification, generated savings of more than $2.6 billion. 
• Overall, OMIG increased its cost savings and recoveries by $272 million, or nearly 9 percent over the prior year without unnecessarily impacting providers or the availability of critical health care services and supports.
• Medicaid recoveries generated through provider audits and investigations accounted for nearly $819 million in savings.
• Enhanced provider communications and educational resources, including nine presentations to over 2,000 providers and stakeholders. 
• Processed 301 self-disclosures, a 22 percent increase in cases from 2021.
• Received more than 3,863 allegations of Medicaid fraud; referred 1,116 cases to other partner agencies, including 199 credible allegations of fraud to the Attorney General’s Medicaid Fraud Control Unit (MFCU).
• Issued 356 Audit Summations, known as “Positive Reports,” indicating that a substantial number of providers are compliant with Medicaid program requirements.
• Granted 19 providers with relief in instances when an OMIG audit could pose a financial hardship to the organization and to ensure beneficiaries’ access to health care services.
• Opened nearly 2,099 investigations and completed more than 2,385.
• Initiated 1,448 audits and finalized 1,123.
• Provided due process protections during OMIG audits, investigations, and reviews, and successfully resolved 56 hearings. 

“In 2022, OMIG delivered on its mission to protect the integrity of the Medicaid program by generating nearly $3.4 billion in Medicaid recoveries and cost savings that are critical to sustaining New York’s health care delivery system. At the same time, the Agency continued to adapt procedures to avoid imposing burdens on health care providers and recipients to maintain access to essential health services,” Acting Medicaid Inspector General Frank Walsh said.

New initiatives and agency highlights in 2022 include: 

• Established and finalized compliance and self-disclosure regulations.
• Launched the controlled substances audit program to ensure pharmacy providers comply with Medicaid requirements. OMIG conducted audits of MCOs and FFS providers and identified overpayments of more than $2.3 million.
• Finalized two Medicaid Managed Care Operating Report reviews to validate the costs reported by MCOs, leading to the full recovery of penalties of nearly $6 million.
• Established the Pharmacy Program Integrity Unit to strengthen agency-wide pharmacy program integrity activities. 

New Yorkers can help fight Medicaid fraud, waste, and abuse by reporting suspicious behavior or incidents to the Office of the Medicaid Inspector General. Anyone who observes instances of potential Medicaid fraud is urged to contact OMIG’s fraud hotline at 1-877-87-FRAUD (1-877-873-7283) or visit the OMIG website at www.omig.ny.gov. Tips can be completely anonymous, and OMIG investigates information from all calls received.