In an effort to fight fraud, improve integrity and quality, and save taxpayer dollars, the OMIG has increased its areas of focus for reviews and audits. Its 2014-2015 work plan details which Medicaid programs are under the scope and what aspects will be primarily assessed. The OMIG has started to look at managed care programs and this will expand under their new plan to include certified home health agencies, personal care services, as well as supported employment services. Compliance with Medicaid regulations is essential and if your organization is audited, strong internal controls can make the difference between positive or negative audit results. Essentially, for any Medicaid dollar received, it is the organization’s responsibility to ensure that services were provided as per Medicaid protocols and that proper support for services billed exists.
To improve the quality of the reviews being performed and to increase recoveries of fraudulent funds, the OMIG’s Audit Plan is organized into Business Line Teams (BLTs) that are specialized, multi-disciplinary teams that help coordinate program integrity activities with other federal, state, and local partners. The Plan contains the following teams:
- Home and community care services;
- Hospital and outpatient services;
- Managed care;
- Medical services in an educational setting;
- Mental health, chemical dependence, and development disabilities services;
- Pharmacy and durable medical equipment; physicians, dentists, and laboratories;
- Residential health care facilities;
To view the chart by the BLTs with a summary of some of the audit areas that are going to be reviewed, click here.
Shari Diamond, CIA
Shari has been with Cerini & Associates, LLP since 2008 where she works primarily with the firm’s school district clients providing internal audit and claims audit services. She has over twenty years’ experience performing internal audits, risk assessments, and compliance reviews, as well as recommending processes to strengthen the internal controls environment while increasing efficiencies. Her prior experience at PWC and Northrop Grumman included performing Information Technology audits.