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New York OMIG Lawyer

In the state of New York allegations of Medicaid fraud are routinely investigated. These types of investigations are often conducted by the Office of Medicaid Inspector General (OMIG). This office will often start an investigation based on the findings from a routine audit. There are times when audits of Medicaid providers show a number of inconsistencies that attract attention. Some audit findings can result in disciplinary or criminal action and more. If someone is accused of negative behavior resulting from such an audit, they should obtain legal representation. This is a time to contact a New York OMIG Lawyer who specializes in OMIG related issues.

Fighting Fraud
OMIG are experts at detecting schemes designed to commit Medicaid fraud. Their goal is to increase the quality of Medicaid by eliminating abuse and waste. The investigations they conduct are designed to detect any providers who commit fraud or abuse of the system. Should abuse or fraud be identified, it may cause an administrative action to be taken as well as a referral for civil or criminal investigation.

Audit Triggers
Many audits are done randomly. There are also a large number of audits that result from an insurer’s system providing more than one red flag. This could be something like an unusually high service volume. This gives the appearance of services being over-utilized. Excessive use of a particular CPT code to document different patient treatments is another red flag. It is understood that patient treatment will involve a variety of things, which should result in a variety of codes. An increase in the amount of code modifiers is also a red flag. This may indicate a number of services were provided for a patient that exceeded care for their condition.

Overpayment Audit
The goal of this audit is to identify any instances where an overpayment has occurred for services provided. This type of audit is initiated after certain red flags are identified. It could also be done as part of a random audit or as part of an effort to decrease spending on healthcare. An overpayment of services is not automatically considered fraud. In many cases, these errors can result from clerical mistakes, changes in cost for a service and more. This situation can often be resolved by having the overpayment be repaid. If there are inconsistencies discovered, the entity being audited will be given a notice. Response to this notice should be done as soon as possible.

Investigations
When an audit reveals what appears to be criminal activity, an investigation will be conducted by state and federal law enforcement officials. This type of investigation is often the result of evidence showing illegal activities like fraud. The investigation could be the result of audit findings, a tip-off from an employee, patient, colleague and more. Law enforcement agencies have developed sophisticated methods for identifying illegal activities. They can obtain and carefully examine data from submitted claims that appear to be part of a fraudulent billing pattern. This type of investigation can have serious consequences. Anything said to investigators can be used to the provider’s detriment during the investigation. When an entity is the subject of such an investigation, they should speak with an experienced New York OMIG Lawyer immediately. They will know how to respond and provide the desired information and records.

New York OMIG Lawyer

Administrative Actions
If an entity is found guilty of Medicaid fraud, there are a number of administrative actions that may be taken. This includes being excluded from providing services under the Medicaid program. There could also be monetary penalties imposed as well as the recovery of Medicaid funds and more. It’s also possible for the fraud to be serious enough that it will be referred to the New York State Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU). This department will conduct an investigation to determine if criminal prosecution is necessary. Depending on the situation, the case can also be referred to other government agencies including the Bureau of Narcotic Enforcement, Office of the Welfare Inspector General and others.

Avoiding Audit Problems
In order to avoid audit problems, an entity needs to regularly review their billing and coding practices to ensure they are compliant with the latest New York state law. This will help with compliance and when submitting claims. It is also possible for the uncommon operating methods of certain practices to cause an appearance of not being compliant with the law. This will often result in suspicion of the Medicaid provider. When this is the case, these entities need to make extra efforts to correctly substantiate and document the accuracy of their submitted claims. Developing an effective process for following the rules is the best way to avoid any problems with an audit. If an entity has any questions about a situation they are facing in regards to compliance, they should speak with an OMIG attorney. They will be able to explain how the law would interpret the billing methods they are using and provide advice on how to avoid problems.

Avoid Negative Consequences
When an entity is prohibited from providing services for the Medicaid program, they can experience financial, professional and other types of harm. It could ruin the careers of people working in the healthcare field. If subjected to an audit or any type of investigation by the OMIG, the goal is to avoid making any mistakes that could lead to long-term consequences. Speaking with an experienced New York OMIG Lawyer can prevent a bad situation from turning into an impossible one.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

 

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