OMIG Recovers $211 Million for TPL from the Feds

Through the action of the OMIG, the New York State Department of Health’s Fiscal Group received the $211 million payment, representing the state’s share of the funds, on Oct. 1, 2013, representing the largest single monetary recovery in OMIG’s history. As you know, this is a result of the Third-Party Liability (TPL) Home Health Care Demonstration Project, a federal project looking at home health care involving dual-eligible recipients, conducted in conjunction with the University of Massachusetts Medical School. New York State’s portion of the money reflects project efforts during the years 2007-10 and totals more than $496 million, with $211 million in state shared funds.

The Centers for Medicare and Medicaid Services (CMS) agreed to allow OMIG and UMass to employ a sampling methodology, enabling project staff to use a 200-case sample universe of claims for dual-eligible beneficiaries who received home care services paid by Medicaid for each year audited.

In the TPL demo following the establishment of the sampling methodology, OMIG and University of Massachusetts Medical School staff applied an extrapolation technique to calculate payments that New York State Medicaid had made that should instead have been made by Medicare first. “The administrative burden posed by the claim-by-claim approach had been enormous,” James C. Cox stated. “The extrapolation and sampling technique are standard processes used in professional auditing, and it makes sense that we were able to employ this technique to achieve the success of this project.”

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871