| OMIG “Extortion” is Subject of Senate Hearing |
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| Thursday, 18 March 2010 12:55 |
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“Extortion” is how NYS Senator Craig Johnson (D-Nassau) described the audit and collection practices of the Office of the Medicaid Inspector General (OMIG) in response to horror stories from healthcare providers. The comments came at yesterday’s hearing by the Senate’s Committee on Investigations and Government Operations, which Johnson chairs.
During the course of the day-long hearing, the Committee heard from John J. Foley, Deputy Medicaid Inspector General for Audit, who faced tough questions regarding various aspects of the OMIG’s operations, including its aggressive audit protocols, burdensome demands for documentation, the attitudes and qualifications of its staff, and its approach to collecting audit recoupments, which Johnson described as “shaking everybody down.”
Foley was followed by two healthcare provider executives who described their own experiences in dealing with OMIG auditors. John Haley described how New York Diagnostic Center, Inc. had been forced to close after OMIG sought recoupment of more than $3 million in payments for same day clinic visits which allegedly should have been provided by an inpatient rehabilitation service, despite what Haley described as prior written approval for the program of services from the Office of Alcoholism and Substance Abuse Treatment Services (OASAS). Haley indicated that the final decision to close came as OMIG moved to “100% withhold” of current Medicaid payments as NYDC continued to fight the audit finding.
Bruce Peckman, Chief Operating Officer of Highfield Gardens Care Center of Great Neck, related three separate audit experiences with OMIG. One involved a base year rate audit going all the way back to 1990 when the facility was under prior ownership which would have ultimately translated into a recoupment claim of more than $30 million. According to Peckman, the facility was ultimately forced to settle for $853,000, despite strongly disagreeing with the finding, after the OMIG had already withheld $800,000 in current Medicaid payments and the threat of significantly higher recoupment had negatively impacted the agency’s ability to obtain credit. Peckman went on to describe two other subsequent interactions in which OMIG staff cited documentation requirements not included in regulation and used the threat of lengthy and expensive legal action as a reason to settle an audit claim.
“Providers are living in fear today,” said Johnson, who noted that many other providers had been reluctant to testify publicly about their experiences with OMIG. He cited the experience of Metropolitan Jewish Geriatric Center, which had won a decision overturning the OMIG’s audit finding after appealing to an Administrative Law Judge. Soon after, said Johnson, the agency had received a new audit notification letter. And, on February 17th, only two days after Johnson had questioned OMIG James Sheehan publicly as to why MJGC had not been repaid the monies withheld by OMIG, the agency reportedly received another letter notifying them that the audit parameters were being expanded. “This looks like a clear example of retaliation and retribution,” said Johnson.
Foley indicated that there were several reasons why, under OMIG’s process for selecting audit candidates, Metropolitan Jewish might have been selected for audits of additional Medicaid services. He stressed that any provider with concerns over the behavior of OMIG auditors should contact him directly. |
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