Recently, the New York Court of Appeals upheld a recoupment of funds by the NYS Office of the Medicaid Inspector General ("OMIG") against a provider, rejecting the provider's claim that it was not sufficiently notified of the recoupment.  After the provider failed to respond to notices and failed to settle claims to a lower estimate within the statutory time-period, OMIG began withholding a percentage of his payments to recover the full amount.  The court held that while the notice was not as clear as it could be, it was sufficient to alert the provider of the recoupment.

It is of utmost importance that Medicaid providers take prompt measures when under audit to avoid such consequences.  New York statutes dictate the procedure necessary to successfully challenge audit findings in detail. Failure to adequately request an appeal can lead to the audit findings taking full force and effect.Providers must therefore take care to respond to OMIG notices in an apt manner and commence timely administrative appeals to challenge audit findings during audit reviews.