Poughkeepsie… Dutchess County Executive William R. Steinhaus has announced the New York State Office of the Medicaid Inspector General (OMIG) has recently completed an audit of payments made to the Dutchess County Department of Mental Hygiene (DMH)
from January 1, 2004 through December 31, 2008 and found the DMH to be in full compliance with applicable Medicaid billing rules and regulations.
According to the OMIG, the purpose of Medicaid payment audits is to ensure:
- Medicaid reimbursable services were rendered for the dates billed;
- Appropriate rate or procedure codes were billed for services rendered;
- Patient related records contained the documentation required by the regulations;
- and claims for payment were submitted in accordance with Department regulations and the Provider Manuals for Clinics.
OMIG audits have been a source of anxiety and fear for many service providers according to a recent article in the New York Nonprofit Press., “The OMIG Who Stole Xmas” by Fred Scaglione. Many providers believe that OMIG audits “focus on the minutia of casework documentation and billing detail – essentially anything they can find to generate a denial of claim.” Provider organizations often have difficulty maintaining 100% compliance with every aspect of Medicaid’s myriad rules and regulations. The article goes on to report that OMIG audits recouped a total of $551 million overpayments during 2008, and that is only the beginning; many more audits have been launched or finalized since 2008. Counties across New York State have been ordered to pay thousands of dollars in repayments.
OMIG conducted a review of payments to DMH for outpatient mental health services paid by Medicaid from January 1, 2004 through December 31, 2008. During that audit period, more than $38 million was paid to DMH for over 421,000 services. Because records were in compliance with billing rules and regulations, OMIG did not require any repayment from DMH.
“We are extremely pleased with the results of the recent OMIG audits with no findings, no takebacks. It is unheard of,” said Dutchess County Commissioner of Mental Hygiene Dr. Kenneth Glatt. “We work very hard to maintain excellent risk management practices and deliver high quality treatment services to the residents of Dutchess County and we believe that this audit shows that is exactly what we do.”