OMIG Audits: NYSHFA meets with DOH

Nancy Leveille and Karen Morris and Carl Pucci in Clinical & Quality

NYSHFA staff met with DOH on Friday, February 19, 2016 to discuss outcomes of current OMIG audits. During our discussion, we highlighted many topics that we first brought to their attention last year. DOH has been working with OMIG to clarify the rules that govern the MDS tool that the audits are based upon. From Friday’s meeting, NYSHFA requested the following solutions:

  • Create a Frequently Asked Question Document for all providers. DOH agreed that they have wanted to create one since our last meeting and will target to have one completed by April 15, 2016.
  • Reevaluate having an independent professional audit contractor, who has experience auditing in other states, provide the auditing service for NYS.
  • Provide education for providers on the auditing process

We continue to recommend to members to have your MDS staff person work directly with the auditors and question items that appear to be opinion based versus fact based according to the RAI manual for the time period of each audit. Providers should be as organized as possible for each audit to assist in ensuring a smooth audit process.

Additionally, DOH did note that they have concerns related to data that raised red flags based on the trends and patterns of practice in a few facilities. Those facilities will be added into the audit cycle to evaluate the nature of these patterns.

NYSHFA will continue to follow up with members’ current concerns from the audits with the DOH staff. In addition, NYSHFA’s President and CEO, Dick Herrick, has an upcoming meeting with Dennis Rosen, NYS Medicaid Inspector General.


Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20

Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36