S U P R A S P I N A T U S

The New York State Office of the Medicaid Inspector General has published its State Fiscal Year 2009-2010 Work Plan. The Work Plan is the agency's "road map" and identifies the audit and investigation areas that it will focus on for the next year. This is the second year that OMIG has issued a work plan, but this year's plan is more comprehensive and has more specifics. The Work Plan is required reading for every New York provider, even if you do not participate in the Medicaid program.

Highlights include the following:

- Board role in compliance process. If a provider is identified as having significant compliance issues, OMIG will inquire into a board's actions to assure that compliance processes and systems are in place and whether board members have exercised reasonable oversight over information and reporting systems.

- High-ordering physicians OMIG will review whether physicians who order a significant number of items or services paid for by Medicaid are complying with State and federal requirements (e.g., are properly licensed and not excluded, are enrolled in the program if they order items in excess of $75,000, and have a physician-patient relationship with the Medicaid beneficiary)

- Off-label use and relationships with manufacturers. OMIG will review the Medicaid claims data to determine the extent of off-label use of certain prescription drugs, and will also review Medicaid claims data and the IRS Form 990 information regarding relationships with pharmaceutical and device manufacturers to determine whether physicians have a potential conflict of interest when ordering a drug or device.

- Hospital financial relationships with physicians. OMIG will review hospital cost report information, minutes of board meetings, outside auditor work papers and related documents to ensure that hospitals are complying with the anti-kickback laws in their financial relationships with physicians. It will focus on payments to physicians for direct patient care and administrative services and the rental of office space to physicians.