Updated Guidance re OMIG OPRA Audits

January 15, 2021

On 1/14, the NYS Council hosted our weekly NYS Council Provider Support Call with our guest speaker Robert Hussar from Barclay Damon and former first deputy at the Office of the Medicaid Inspector General (OMIG).  Mr. Hussar provided information and some general advice regarding the OMIG OPRA Audits currently underway.

As you know, this is a rapidly evolving situation.  Subsequent to the event, Bob obtained important additional information which indicates that the OMIG OPRA audits are likely to be expanded very shortly.  This changes the strategy we discussed during the Thursday morning call with Hussar.  

Based on information Bob obtained after our live event, Bob now suggests that those providers not currently under audit should seriously consider immediately adjusting previously submitted claims by adding any additional information (referring provider information) that existed at the time the claim was submitted, and that supports OPRA requirements. If you are inclined to move ahead with this process, Bob suggests you begin as soon possible given  that the six year clock is running. Bob says that you can go back to claims submitted 6 years from the date you begin the process. At the present time, you may only be able to access the last 2 years of claims (older claims may be archived in the EMedNY system).  State representatives will be speaking with DoH about how providers can access older claims. In the meantime, we suggest providers immediately begin to collect necessary information.   Those providers currently under OPRA audit should immediately consult with counsel on how to proceed.

Remember:  The recording on 1/14 occurred BEFORE we received additional information (above) from Bob Hussar.  If you pass the recording link on to others in your information, please make sure they also see this email.  

Below please find the 3 resources discussed during the 1/14 call to assist you.


-The (federal) OIG audit mentioned during the call is here:  https://oig.hhs.gov/oei/reports/oei-05-19-00060.pdf;

-The administrative decision that, while not directly on point, may be helpful to our members is here:   https://www.health.ny.gov/health_care/medicaid/decisions/docs/statewide_ambulette_services_inc_2015-10-28.pdf

-Bob Hussar can be reached at (518) 487-8258.

As always, please reach out to me if you would like to talk it over.  I’m at (518) 461-8200 at your convenience.