March 17, 2021
The NYS Council recently sent all members an Alert from Hiscock Barclay discussing a recent Administrative Law Judge (ALJ) case determination that seemed like it could impact the outcome of ongoing discussions between the state agencies, OMIG and DOH regarding the OMIG OPRA audits (BD Alert pasted directly below).
More recently, I asked our attorney Robert Hussar to prepare a short analysis of the ALJ case and comment on its’ potential to strengthen our claims regarding the unjust nature of the audits (see attached).
Finally, to refresh your memory I have attached is a copy of the brief note we sent to all members early this week with a short update on OPRA audit negotiations at the state level.
Barclay Damon Alert
Matter of Poole: OMIG “System Match” Data Audits Rejected as a Basis for Findings
Barclay Damon is very excited to report a key decision in our client’s favor after a hearing dealing with the core issues in all of our “coordinated” data match OMIG audits involving over $8 million in initial findings.
In a critical decision in a lead case issued after four days of hearing, our Barclay Damon Transportation Audit Team obtained a favorable decision that has now yielded clear precedent that will limit and even end the slew of audits that ignore valid, contemporaneous provider documentation and rely solely upon claims entry data that we and our experts believe is flawed and corrupted.
OMIG had pursued over 100 “system match” audits based solely upon claiming data, but refused to consider valid claiming documentation. In a trio of cases, binding upon OMIG and culminating in Poole, the agency’s ALJ’s have now foreclosed OMIG’s use of this lucrative, but highly controversial, auditing practice that threatened to render documentation requirements moot and cause a complete forfeiture of payments to providers based upon novel and immaterial inconsistencies or errors in electronic claiming data. This is good news for providers of all kinds who may resort to documentation kept per regulations to support claims upon audit.
If you are facing payer or governmental audit liabilities, contact the firm’s Health Care Controversies Audit Team for a free consultation as early as possible in the process to see how we can help.