Office of Medicaid Inspector General
The Office of Medicaid Inspector General (OMIG) is another major player on the scene of Medicaid Fraud investigations in New York.
The OMIG largely deals with Medicaid providers and to a lesser extent with recipients.
The OMIG investigations may often begin as routine audits of Medicaid providers, and then, depending on the circumstances, the audit may result in an overpayment claim, or a referral to a third agency for a criminal or disciplinary action.
The OMIG may also penalize providers by excluding them from participating in the Medicaid program. This happens at the OMIG’s discretion when the agency believes that the Medicaid program could be jeopardized if the practitioner continues to bill it.
Medicaid exclusions are normally triggered by:
- Criminal convictions (especially for fraud crimes)
- Fraudulent Medicaid billing (even if not criminally charged)
- Certain types of professional misconduct
If you are excluded from participating in the Medicaid program, you can’t perform any services for which Medicaid is paying. This may effectively end your career in many healthcare related fields.
If you are under an audit or an investigation by the OMIG, there is a lot at the stake, so don’t make the problem worse by speaking with the investigators or giving them any documents before you speak with us.
Check out our page where we discuss what to do and not to do when you are under investigation.