A Medicaid managed care audit in New York may start with a health plan’s Special Investigation Unit, an outside audit vendor, or the New York State Office of the Medicaid Inspector General. The letter may ask for medical files, orders, service logs, billing support, employee information, or records tied to a defined group of claims. […]
About Norman Spencer
OMIG Self-Disclosure in New York: When Should a Provider Consider It?
A billing error does not always arrive with an audit letter. It may surface during a routine claims review, an employee report, a software check, or a review of documentation that does not support what Medicaid paid. Once a New York provider identifies an improper Medicaid payment, the issue moves from an accounting concern to […]
What Happens When a New York Provider Gets an OMIG Education Letter?
An OMIG education letter can look less serious than an audit demand, but New York Medicaid providers should still take it seriously. The letter may not accuse the provider of fraud. It may not demand repayment right away. It may not ask for boxes of records by a strict deadline. Still, it can be an […]
Medicaid Billing for Deceased, Hospitalized, or Incarcerated Patients in New York
Medicaid billing fraud investigations in New York often begin with a simple question: could the patient have actually received the billed service on that date? For New York providers, billing companies, transportation companies, clinics, home care agencies, and other Medicaid participants, that question can turn into a serious problem when claims appear under the names […]
Medicaid Transportation Fraud New York: Why Transportation Companies Are Facing More Scrutiny
Medicaid transportation fraud investigations in New York have become a serious concern for ambulette companies, taxi providers, livery operators, dispatch services, and owners involved in non-emergency medical transportation. For many transportation companies, the business can look simple from the outside. A patient needs a ride to a medical appointment. A driver picks them up, takes […]
What New York Providers Should Know About the OMIG 2026 Work Plan
The OMIG 2026 Work Plan gives New York Medicaid providers a clear look at where state enforcement attention may land this year. For physicians, clinics, pharmacies, home care agencies, transportation companies, behavioural health providers, nursing homes, managed care plans, and other Medicaid participants, the plan is not just an agency update. It is a practical […]
