NYS Office of the Medicaid Inspector General – Albany, NY

Protecting the Integrity of New York’s Medicaid Program

The New York State Office of the Medicaid Inspector General (OMIG) is an independent agency dedicated to preventing and detecting fraud, waste, and abuse within the state’s Medicaid program. Headquartered at 800 North Pearl Street in Albany, OMIG operates as a distinct entity administratively attached to the Department of Health. Its primary mission is to ensure that Medicaid funds are used effectively to serve eligible recipients, recovering improper payments and holding providers accountable for billing discrepancies . By conducting rigorous audits and investigations, OMIG safeguards taxpayer dollars and maintains the financial viability of New York’s healthcare safety net.

Audits and Compliance

OMIG’s Audit Division plays a central role in monitoring Medicaid providers, including hospitals, nursing homes, pharmacies, and managed care organizations. The agency conducts compliance reviews to verify that services billed were actually provided and documented in accordance with state regulations. When overpayments are identified, OMIG pursues recovery through administrative processes or settlements. The office also works proactively with providers to establish Compliance Programs, offering guidance and self-disclosure protocols to help healthcare organizations identify and correct errors before they become systemic issues .

Fraud Detection and Enforcement

The Division of Medicaid Investigations handles allegations of fraud and illegal activities. This includes investigating credible reports of billing for services not rendered, kickbacks, and identity theft. The agency manages a dedicated Fraud Hotline where the public and whistleblowers can report suspicious activities anonymously. OMIG collaborates closely with the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) and federal partners to prosecute serious offenses . Additionally, the agency has the authority to exclude providers from participating in the Medicaid program if they are found to have engaged in unacceptable practices.

• Audits: Review of provider billings and service documentation.
• Fraud Reporting: Management of the Medicaid Fraud Hotline.
• Recovery: Recoupment of inappropriate or excessive payments.
• Compliance: Oversight of provider compliance plans and self-disclosures.