The New York State Office of the Medicaid Inspector General (OMIG) has introduced an enhanced Audit Protocols page to provide Medicaid providers with a centralized resource to navigate compliance requirements. This update offers greater clarity on protocol development timelines and gives providers valuable tools to prepare for audits.
OMIG’s updated page includes:
- Anticipated Protocol Release Schedule – Providers can now see when new protocols are expected, helping stay ahead of compliance updates.
- Development Insights – Clear explanations of how protocols are created and applied are now provided.
- Historical archive – A searchable archive of previous protocols, which allows providers to track regulatory changes over time, is now available.
OMIG’s audit protocols are designed to evaluate provider compliance with Medicaid requirements but do not replace statutory or regulatory obligations. In cases of conflict, statutes and regulations take precedence. These protocols apply to fee-for-service provider types or category of services and help assess the appropriateness of Medicaid expenditures. Providers should maintain thorough documentation to support claims submitted in case of an audit.
The new page also provides insight into how OMIG develops its audit protocols. OMIG follows a four-phase process to ensure audit protocols are comprehensive and practical:
- Phase 1: OMIG subject matter experts research and review relevant laws, regulations, and program agency guidance. Then, subject matter experts draft the initial set of protocols.
- Phase 2: Draft protocols are sent to the program agency for review. OMIG and the program agency collaborate to discuss the program agency’s feedback. OMIG then revises protocols as needed.
- Phase 3: Internal OMIG review occurs, encompassing both quality assurance and legal review.
- Phase 4: Provider associations are given the opportunity to review the drafted protocols. OMIG reviews all submitted association feedback, and revisions are made as necessary. The protocols then go through a final review by OMIG. After the final review, the audit protocol is published on OMIG’s website.
OMIG’s protocols evolve over time in response to legal rulings, statutory changes, and emerging compliance risks. The anticipated release schedule and archives section enable providers to stay informed and understand historical compliance trends.
OMIG’s enhanced protocols page reinforces its mission to help Medicaid providers meet their legal obligations and maintain compliance. This effort aligns with OMIG’s broader mission to prevent fraud, waste, and abuse within the Medicaid program.
To explore the new protocols page, click here.
To view archived protocols, click here.
Barclay Damon’s Health Care Controversies Practice Area attorneys have decades of experience handling governmental audits and investigations, including OMIG audits. If you need assistance or advice, please contact Linda Clark, Health Care Controversies Team co-leader, at lclark@barclaydamon.com; Tricia Lu, associate, at tlu@barclaydamon.com; or another member of the firm’s Health Care Controversies Team.