Relates to enforcement actions by the office of the Medicaid inspector general

BILL NUMBER:S2554

Title of bill

An act to amend the public health law, in relation to enforcement actions by the office of the Medicaid inspector general

Purpose

To align the extrapolation rate used by the State Medicaid Inspector General with the rate used by federal government in Medicaid audits.

Summary of provisions

Section one amends the public health law by adding language that requires the Medicaid Inspector General to determine that any error exceeds a rate of 5% in the audited sample prior to applying any extrapolation method.

Justification

In 2006. the Legislature created the Office of the Medicaid Inspector General (OMIG) to coordinate anti-fraud efforts within the Medicaid program. The Legislative intent of enacting statute states that the OMIG was intended to "create a more efficient and accountable structure, dramatically reorganize and streamline the state's process of detecting and combating Medicaid fraud and abuse and maximize the recoupment of improper Medicaid payments." At the time of passage, there was nearly unanimous support for an institution to crack down on fraud within the Medicaid system.

This bill will ensure that billing errors or oversights are not confused with fraud or systematic problems resulting in overbilling the Medicaid system. By limiting any extrapolation to the rate utilized by the federal Department of Health and Human Services, State audits will mirror the standards set by the US Centers for Medicare and Medicaid Services.

Legislative history

2011-12: S. 4806-A: Referred to Health

Fiscal implications

None.

Effective date

This act shall take effect next succeeding January, and apply to enforcement actions commenced on or after such date.