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January 13, 2023

Linda Clark Interviewed for Crain's Health Pulse Article on New York State Medicaid Audit Reform

Linda Clark, Health Care Controversies Team leader, was quoted extensively in the Crain’s Health Pulse article, “After Hochul Vetoes Bill, Advocates Renew Focus on Medicaid Audit Reform.” The article provided background on S.4486B/A.7889A, which would have limited the New York State Office of the Medicaid Inspector General’s ability to fine providers for errors found during audits. New York State Governor Hochul vetoed the bill on the grounds that, if passed, auditors would be limited in their ability to enforce Medicaid rules and standards and to detect fraud.

Linda explained how auditors go about finding errors in claims, which can result in providers losing millions of dollars and even closing their doors. “We are almost always talking about meaningless, nonmaterial, clerical errors that have nothing to do with whether or not Medicaid should have paid the claim, or whether or not the person got the services,” she said.

If the bill had been passed, it would have lessened the consequences for providers who are fined for errors found during audits. Linda said, “The bill was really designed to rein in some of the outlier practices that had been identified by the legislature as really being unfair and not in keeping with the spirit . . . of OMIG’s charge, which is program integrity.”

Additionally, the bill would have offered providers guidelines as well as information regarding protocols. The provider community has requested Governor Hochul facilitate a discussion between Medicaid provider organizations’ representatives about the issues the bill sought to address and develop of plan of action. Governor Hochul recommendations OMIG focus on improving its program and audit processes. 
 

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