Post-Payment Audit Guidance


The Office of the Medicaid Inspector General (OMIG) is an independent entity within the New York State Department of Health (DOH) whose mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high quality patient care. OMIG, in collaboration with DOH and the Center for Medicare and Medicaid Services (CMS), performs post-payment audits to ensure the compliance and integrity of the New York State Medicaid EHR Incentive Program.

Within OMIG, the Division of Medicaid Audit (DMA) conducts audits and reviews of Eligible Professionals (EP) and Eligible Hospitals (EH) for adherence to program requirements and, where necessary, to recover overpayments. The primary focus of post-payment audits is to ensure provider compliance with Medicaid EHR Incentive Program requirements and adherence to laws, regulations, rules and policies of the Medicaid program as set forth in New York Public Health Law, the regulations of the Education Department (Title 8 of the New York Codes Rules and Regulations), the regulations of the Department of Mental Hygiene (Title 14 of the New York Codes Rules and Regulations),New York Social Services Law, the regulations of DOH (Titles 10 and 18 of the New York Codes Rules and Regulations) and DOH´s Medicaid Provider Manuals and Medicaid Update publications.