Governor Cuomo Announces $58 Million in Medicaid Savings Through Corporate Integrity Agreements

Avoids Overbilling Costs That Would Have Been Paid by Taxpayers.

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Albany, NY - May 7th, 2014 - Governor Andrew M. Cuomo today announced that New York’s Medicaid program saved taxpayers more than $58 million in 2013 through the use of corporate integrity agreements (CIAs) to monitor and improve provider operations. This announcement by the Governor and the Office of the Medicaid Inspector General (OMIG) comes during National Corporate Compliance and Ethics Week 2014.

“Three-and-a-half years ago, we said we would change Medicaid in New York by cutting the waste and bureaucracy to better serve those who benefit from these services the most—taxpayers. That is exactly what we have accomplished,” said Governor Cuomo. “This state leads the nation in Medicaid recoveries and compliance efforts, proving that the use of ‘Corporate Integrity Agreements’ are worth the investment. I applaud the Office of the Medicaid Inspector General for continuing to find savings for taxpayers while maintaining the high quality of service New York is known for.”

CIA agreements are offered by OMIG to providers with a history of program integrity issues as an alternative to exclusion from the Medicaid program, when exclusion might lead to extenuating circumstances such as service shortages within a given geographical area. Providers who enter into a CIA are required to learn about compliance and create compliance-testing structures. Each provider subject to a CIA must also pay for an independent review organization (IRO) which reports to OMIG and monitors provider adherence to the CIA. These activities result in cost avoidance to the Medicaid program which totaled $58,090,814 in 2013.

Medicaid Inspector General James C. Cox said, “Measuring the effect of CIAs gives us a handle on some of the impact of our expanded compliance efforts. Improving provider regulatory adherence has the added benefit of saving taxpayer dollars.”

Each CIA is unique, as is each provider. If the IRO detects a material breach of the terms of the CIA and reports this to OMIG via the monitoring process, the provider may ultimately be excluded from the Medicaid program. However, the goals of the CIA process are to improve the provider’s program integrity efforts, to educate providers about ways in which they can improve their compliance programs which directly relate to detection of internal risk areas, and lead to preventing and reducing fraud, waste and abuse in the Medicaid program.

Two major features characterize CIAs. The first is heightened monitoring of the “eight elements” of the compliance program required under Part 521 of New York’s Code of Rules and Regulations (NYCRR) for Medicaid providers. The second is overseeing providers’ progress in correcting issues, including improvements in provider billing and record-keeping systems, among others, that contributed to the unacceptable practice(s) that gave rise to the need for a CIA. OMIG has maintained CIAs since 2009, and all providers who are being monitored under CIAs are listed on OMIG’s Web site under the Compliance section.

During National Compliance Week 2014, OMIG will post new compliance information and updates every day. Additionally, OMIG will host a live tweet session from 1-2 PM via OMIG’s Twitter feed (@NYSOMIG), using #ComplianceNY, when members of the provider community will have the opportunity to tweet questions to OMIG’s compliance team and receive responses. Providers can send questions in advance to for consideration for answers during the live session.

New Yorkers can assist the Office of the Medicaid Inspector General in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents. OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG’s fraud hotline at 1-877-87-FRAUD or visit the Web site at Tips can be completely anonymous, and OMIG investigates information from all calls received.

Some Twitter Tips:
Be a part of the national Corporate Compliance and Ethics Week conversation: #2014CCEweek
Be Part of the conversation in New York by adding #ComplianceNY to your tweets.