Our OMIG Reform Advocacy Continues

August 25, 2022

Our letter to Governor Hochul, urging enactment of the OMIG Reform bill that passed in both houses of the legislature in June, is getting media attention here in NYS and across the country.  Yesterday there was an item in Politico Pro (pasted at bottom) and today, Crain’s Health Pulse has a story that continue their coverage of an OMIG audit  back in 2020 that resulted in Mt. Sinai/Beth Israel Hospital having to shutter one of their OTPs due to a total of 12 clerical errors that, when extrapolation was applied, resulted in a $7.7M fine.  Our advocacy partners at COMPA operate OTPs all over the state and have been at the forefront of OMIG Reform ever since.  !!

Also please find the final Press Release that was sent far and wide on Monday.


Medicaid providers press Hochul to sign bill limiting auditors’ ‘punitive’ fines

Maya Kaufman, Crain’s Health Pulse, 8/25

Medicaid providers are calling on Gov. Kathy Hochul to sign legislation that would limit the Office of the Medicaid Inspector General’s powers to impose exorbitant fines for administrative or technical issues discovered during an audit.

The bill, S.4486B/A.7889A, passed the state Senate and Assembly unanimously in May and now heads to Hochul’s desk for her signature or a veto. It would require the Office of the Medicaid Inspector General to notify providers if their compliance program is unsatisfactory and allow them 60 days to submit a proposal to make it satisfactory. In addition, it would prohibit repeat reviews or audits of the same records within three years, unless the office has good reason to believe the previous audit was erroneous.

A coalition of 45 organizations and advocacy groups signaled support for the bill in a letter sent to the governor’s office last week, calling the legislation necessary to make the medical assistance audit program fairer and more transparent.

The bill’s supporters primarily take issue with OMIG’s practice of assessing a sample of a provider’s claims, then extrapolating the findings. 

To illustrate the consequences, they point to Mount Sinai Beth Israel’s opioid treatment program, which shuttered after OMIG auditors fined it $7.7 million in 2020, Crain’s Health Pulse reported at the time. The audit had identified 12 clerical errors among a random sample of 100 claims, adding up to roughly $408 in alleged Medicaid overpayments.

”For too long, audits conducted by the OMIG have included the use of tactics that fail to take a transparent, or fair and balanced approach to the audit and recovery process,” the letter said. “As a result, providers who have operated in good faith and delivered high-quality care to clients, but who may have made human errors in the process, have been punished as if they had intentionally and maliciously defrauded the state.”

Asked for comment on the governor’s stance, spokesman Avi Small said only that Hochul is reviewing the legislation.

OMIG was created in 2007 to serve as a watchdog, sniffing out waste and fraud in the state’s Medicaid program. Allegra Schorr, president of the Coalition of Medication-assisted Treatment Providers and Advocates of New York State, said she supports the office’s mission, but the “enormous” fines do not further its mandate to root out fraud and abuse.

Schorr, whose coalition of 45 member providers treats more than 41,000 New Yorkers statewide, compared OMIG’s fines to parking tickets. In both cases, she said, authorities are trying to make sure that people are following the law, but they also generate substantial revenue by doing so.

The practice jeopardizes the already precarious financial state of Medicaid providers, Schorr said, and may discourage health care organizations from serving Medicaid patients. 

“It has a chilling effect,” she said.

State Sen. Pete Harckham, who sponsored the bill in his chamber, said the state cannot afford to lose more drug treatment providers like the Beth Israel program.

“Let’s not lose sight that these programs save lives,” he said in a statement, “so regulatory efforts should be in line with supporting and improving services, not crippling them.” —Maya Kaufman


Political Pro, 8.24

PLEASE SIGN — More than 40 organizations that represent New York Medicaid providers called on Hochul on Monday to sign legislation ( NY A7889 (21R) )/( NY S4486 (21R) ) that they argue would “provide protections for Medicaid providers and consumers related to audits performed by the Office of the Medicaid Inspector General,” Shannon reports.

The 46-organization coalition, led by Coalition of Medication-Assisted Treatment Providers and Advocates of New York State President Allegra Schorr and New York State Council for Community Behavioral Healthcare Executive Director Lauri Cole, sent a letter to Hochul urging her endorsement of the bill.

The legislation, they wrote, “is necessary to ensure fairness and balance in the medical assistance audit program, and to provide critical transparency in the auditing process which is lacking today.”