Edwin Lake

The Office of the Medicaid Inspector General (OMIG) outlines its 2026 Work Plan, detailing key focus areas and program-integrity initiatives for the year. The plan emphasizes enhancing the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices. Strategic pillars include various types of Medicaid audits (Managed Care, Provider, System Match), Third-Party Liability Match, Recovery Audit Contract and Unified Program Integrity Contractor reviews, Casualty & Estate/Medicaid Liens Reconciliations, Collections, managing Lost, Destroyed or Damaged Records, ensuring Compliance and Self-Disclosure, and conducting Investigations.

The Office of the Medicaid Inspector General's (OMIG) document, dated November 13, 2025, outlines its key focus areas, priorities, and path forward, including plans for 2026. OMIG's mission is to enhance the integrity of the New York State Medicaid program through fraud prevention, waste detection, fund recovery, and promotion of high-quality patient care. The guiding principles include maximizing program integrity, improving stakeholder relationships, strengthening compliance, promoting quality of care, and preserving Medicaid resources. Key activities and plans for 2026 encompass expanding Medicaid Managed Care Audits, managing Home & Community-Based LTC Services, addressing lost records, enforcing Electronic Visit Verification (EVV), conducting compliance program reviews, and optimizing the self-disclosure process.

This Integrated Care Roadmap outlines the New York State Department of Health's strategic direction for improving integrated care for Medicaid members who are dually eligible for Medicare and Medicaid. The plan is guided by four goals: building alignment between Medicare and Medicaid MCO offerings, streamlining MCO offerings to promote informed member choice, enabling fewer member transitions and stronger continuity of care, and simplifying administrative infrastructure for providers and MCOs. Key initiatives include streamlining enrollment pathways, enhancing dual eligible plan coverage and benefits, leveraging new contracting requirements, developing member and provider education, expanding PACE enrollment opportunities, and unifying grievance and appeals processes. The overarching vision is to improve outcomes, enhance member satisfaction, and reduce costs, with a target to achieve a 250% increase in integrated care by the end of 2023.

The Medicaid Work Plan for the New York State Office of the Medicaid Inspector General (OMIG) focuses on enhancing the integrity of the Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices. Key areas of focus include compliance, governance, third-party payments, mandatory reporting of overpayments, pharmacy issues, home health and personal care, evaluation and review, employee training, and beneficiary outreach. The plan aims to improve program integrity, reduce improper payments, promote high-quality patient care, and ensure accountability and transparency in the Medicaid program.

The strategic plan for the New York State Office of the Medicaid Inspector General (OMIG) focuses on promoting diversity and inclusion within its workforce. It outlines priorities and goals to cultivate a diverse and inclusive culture where employees feel welcomed and motivated. The plan addresses key areas such as reviewing policies, analyzing workforce data, enhancing outreach and recruitment, ensuring equitable appointment processes, promoting employee engagement, and providing relevant training and development opportunities. The aim is to create a supportive work environment that reflects the diversity of the residents of New York State and enhances the integrity of the Medicaid program.