Office of Medicaid Inspector General
The budget enacted by the Legislature makes the following changes to the Executive Budget (analysis as of March 30, 2006):
· Makes no changes to the Executive Budget’s appropriation for the Office.
· Omits Article VII language that establishes the Office, moves employees from other agencies to it, and provides its statutory direction. The Senate and Assembly cannot agree on the length of the term of office for its Director and whether or not to permit independent citizens to bring lawsuits on Medicaid fraud. It is unclear how this dispute will be resolved and how the office will operate without statutory authorization and direction.
The Senate and Assembly made the following changes to the Executive Budget (analysis as of March 16, 2006):
Senate:
· Included no noticeable monetary changes from the Executive Budget OMIG appropriation proposal.
· Provided the appropriate civil service “transfer of function” language in the Article VII bill that governs the transfer of employees from other agencies to OMIG.
Assembly:
· Eliminated the $5 million maintenance undistributed appropriation for a contract with the SUNY research Foundation for related services. Their Budget Resolution statement said that they would reprogram the money to hire new Medicaid auditors but they did not add this money to their proposed budget for OMIG and instead said the Governor would have to resubmit his budget bill with the additional $5 million for Medicaid auditors.
· Included the Executive Budget Article VII vague transfer of employee language within their OMIG legislative proposal.
The 30 day amendments to the Executive Budget recommend the following changes (analysis as of February 8, 2006):
· Increases the Medicaid Audit and Fraud Prevention Program’s Maintenance Undistributed appropriation by adding a $1 million appropriation for office space and rent (the total maintenance undistributed appropriation for this program is nearly $12.7 million).
· Transfers $3.7 million in funding from the Department of Health’s Maintenance Undistributed Program, Recoveries and Revenue Account to the Office of Medicaid Inspector General’s (OMIG) Maintenance Undistributed account. This funding is an offset to the General Fund-state purposes account of the OMIG.
The Executive Budget recommends (revised analysis as of January 24, 2006):
· An increase of 81 FTEs in SFY 2006-07 from the adjusted 3/31/06 FTE level. In SFY 2005-06 there was a net decrease of 100 FTEs within the Department of Health (DOH) Medicaid Audit and Fraud Prevention program (which is now part of OMIG) during the fiscal year. According to DOH leadership these were not filled positions. Accounting for the 100 unfilled positions from 2005-06, even with the 81 “new” FTEs, there are effectively 19 less FTEs to fight Medicaid fraud, a mission for which OMIG was said to be specifically created to fulfill.
· An all Funds appropriation of $94.6 million. This is an increase of 4.3% from what the program received in SFY 2005-06 (the program was formerly housed directly under DOH).
· The establishment of an independent Office of Medicaid Inspector General will involve the transfer of existing audit and investigative resources from various State agencies to OMIG. According to the Agency’s Executive Budget Presentation, OMIG will be comprised of 627 staff, 411 State anti-fraud positions, along with 135 contract employees transferred from the DOH and other agencies and 81 new state positions. Approximately 55% of the positions are supported by the General Fund and the remaining 45 percent are supported by Federal and other funds. The extent of existing positions versus new positions is not clear and needs to be clarified at statewide labor-management.
· According to the Assembly’s 2006 Yellow Book the 627 full-time equivalent positions, including the 81 new positions and FTEs transferred from other agencies will consist of:
o current Office of the Medicaid Inspector General Staffing (15 FTEs);
o transferred staff from the Department of Health (389 FTEs);
o transferred staff from OMRDD (5 FTEs);
o transferred staff from OASES (2 FTEs);
o new staff (81 FTEs); and
o contract staff (135 FTEs).
· The Executive Budget claims there is additional funding provided to fight Medicaid fraud, waste and abuse, including contracting out services. Specifically $11.7 million can be identified within the Maintenance Undistributed funding as being related to fighting Medicaid fraud. This includes: $5 million to contract with clinicians at the State University of New York to provide clinical and medical expertise; and $5 million that is likely to support the transfer of employees from various State agencies to OMIG. However, the increase of $10.5 million for Maintenance Undistributed is offset by the $10.7 million decrease in Special Revenue-Federal funding. This raises the issue of whether there really are additional resources to fight Medicaid fraud. This issue should be raised and clarified at statewide labor-management.
· Article VII language provides for the transfer of existing audit & investigative employees from various State agencies (DOH, OMRDD, OMH, and OASAS) to OMIG. Additionally it states that the employees and Officers will be transferred without further examination or qualification, and will retain their respective civil service classification and status. The Article VII bill creating OMIG does not provide the normal civil service “transfer of function” provisions that govern the transfer of employees from other agencies to OMIG. This issue should also be addressed at statewide labor-management.
Office of Medicaid Inspector General - (formerly in the DOH)
Program Details-State Operations
Enacted
Proposed
Enacted
Change in
Percent
Program
2005-06 Budget
2006-07 Budget
2006-07 Budget
Appropriation
Change
All Funds
$90,665,000
$95,596,000
$95,596,000
$4,931,000
5.4%
General Fund
$20,365,000
$32,323,000
$32,323,000
$11,958,000
58.7%
Special Revenue - Federal
$65,800,000
$55,073,000
$55,073,000
($10,727,000)
-16.3%
Special Revenue - Other
$4,500,000
$8,200,000
$8,200,000
$3,700,000
82.2%
MA Audit and Fraud Prevention
$20,365,000
$36,023,000
$36,023,000
$15,658,000
76.9%
Personal Service
$15,529,000
$18,872,000
$18,872,000
$3,343,000
21.5%
Nonpersonal Service
$3,687,000
$4,452,000
$4,452,000
$765,000
20.7%
Maintenance Undistributed - (MU)
$1,149,000
$12,699,000
$12,699,000
$11,550,000
1005.2%
Svcs & Exp Medicaid Fraud - (MU)
$1,149,000
$1,149,000
$1,149,000
$0
0.0%
Medicaid Audit & Fraud Contracts - (MU)
$0
$5,000,000
$5,000,000
$5,000,000
100.0%
Medical Asstnc Prg - Transfer to SUNY - (MU)
$0
$5,000,000
$5,000,000
$5,000,000
100.0%
Office Space and Rent - (MU)
$0
$1,000,000
$1,000,000
$1,000,000
100.0%
Svcs & Exp for Outside experts for Litigation - (MU)
$0
$550,000
$550,000
$550,000
100.0%
Special Rev. -Fed (SRF)
$65,800,000
$55,073,000
$55,073,000
($10,727,000)
-16.3%
Special Rev. -Other (SRO)
$4,500,000
$4,500,000
$4,500,000
$0
0.0%
Fed Health & Human Svcs - (SRF)
$65,800,000
$55,073,000
$55,073,000
($10,727,000)
-16.3%
Quality Assurance & Audit Rev activities - (SRO)
$4,500,000
$4,500,000
$4,500,000
$0
0.0%
Maintenance Undistributed
$0
$0
$0
$0
General Fund Offset
$0
($3,700,000)
($3,700,000)
($3,700,000)
100.0%
Special Revenue - Other (SRO)
$0
$3,700,000
$3,700,000
$3,700,000
100.0%