August 19, 2025

(NYS Council communication to members 8/18 ppm is now partially updated with additional info bolded below)

Good evening,

As you know, the NYS Council has been leading a statewide advocacy effort to compel state lawmakers to pass legislation that would infuse much needed balance and transparency into the OMIG audit process.  Last week during our Thursday call we talked to members about the need to continue our advocacy on this front.  But in the meantime, I think we have some good news to share.

I just spoke with Linda Clark, our attorney at Barclay Damon.  Linda informed me that officials at OMIG have confirmed to her firm (verbally) that going forward, providers that may previously have been reluctant to dispute an OMIG audit finding and go before an administrative law judge on the matter because the provider is afraid of losing the hearing and being forced to pay the ‘upper confidence’ recoup number (current policy) should consider this choice carefully and talk it over (again) with your attorney.  Apparently OMIG has heard our very loud and consistent concerns about how fundamentally unfair this tactic is.  

While you could still wind up paying at the higher recoup confidence level (if you lose the ALJ hearing) this policy change allows the provider and attorney to speak to an attorney in OMIG Counsel’s Office first and make your case on a resolution (while the draft recoupment amount is held at the lower confidence number).  

As it currently stands, provider and provider attorney are often unable to talk to a lawyer in OMIG Counsel’s Office until the actual hearing.  The ability to talk to OMIG Counsel’s Office before the hearing occurs on a case by case basis and only based on very persistent advocacy, however going forward you will have the benefit of a discussion (if requested) with OMIG counsel first, to see if you can come to a resolution before the hearing while the lower confidence number is still in place.  

Linda Clark is fantastic and she is speaking at a Lunch n Learn event tomorrow when she will briefly discuss this latest development.  Tune in if you can.  Registration info below.

*If you have a Compliance Officer on staff they may already know about the event tomorrow if they are part of the NYS Council’s Compliance Workgroup that meets monthly.  If they are not part of the group, they should join us!  Write to:  cindy@nyscouncil.org  and we will add you to the listserv that includes announcements of upcoming meetings.  

Recent Developments With OMIG and Other Audits

Topics Will Include:

• Increased Focus on Compliance Reviews and Broadening of Scope
• Recent OMIG and Court Decisions Impacting Providers
• New Standards and Protocols Issued in Various Provider Areas 
• How Recent Budget Cuts and Executive Orders Could Impact How States Approach Auditing Functions 
• Top Five Things NOT to Do When You’re Audited or Investigated 

Thursday, August 19, 2025
Noon–1:00 p.m. EDT

Presented by
Linda Clark, Health Care Controversies Team Co-Leader

Moderated by
Bob Hussar, Of Counsel

Register here. 

If you have any questions regarding this webinar, please contact Linda Clark, Health Care Controversies Team co-leader, at lclark@barclaydamon.com, or Bob Hussar, of counsel, at rhussar@barclaydamon.com.