By Bill Hammond, EmpireCenter.org https://www.empirecenter.org/publications/nys-medicaid-fraud-watchdog-shows-declining-performance |
Enforcement by the New York’s Office of Medicaid Inspector General has dropped in recent years across a range of benchmarks – a sign that the state’s anti-fraud efforts have slackened even as its Medicaid spending soared.A review of annual reports from the office, known as OMIG, shows that the number of audits it has generated, the amount of money it has recovered and the number of cases it has referred to other agencies have all declined in recent years.From 2019 to 2024, audits were down 62 percent, inflation-adjusted recoveries were down 27 percent and total referrals were down 44 percent (see table). During that same period, New York’s Medicaid spending increased 65 percent, from $72 billion to $101 billion, and OMIG’s staffing rose 17 percent, from 391 to 472.As a result, the number of completed audits per billion in spending dropped to its lowest level in the agency’s 20-year history, while the number of audits per full-time equivalent employee dropped to its second-lowest level (see charts).  Established in 2006 as an independent agency within the Health Department, OMIG is charged with defending against fraud, waste and abuse in Medicaid, a safety-net health plan for the low-income and disabled. Under its original director, James Sheehan, the office developed a reputation for aggressive enforcement – and drew complaints from the state’s politically powerful healthcare industry. |