• Decision Rejects OMIG Extrapolation - But Upholds Medicaid Recoupment for Documentation Failures
  • August 25, 2010 | Authors: Pamela A. Madeiros; Francis J. Serbaroli
  • Law Firms: Greenberg Traurig, LLP - Albany Office ; Greenberg Traurig, LLP - New York Office
  • In Rite Aid of New York, Inc., the judge refused to allow the Office of Medicaid Inspector General (OMIG) to extrapolate the findings in a sample of audited pharmacy claims to a universe of nearly 135,000 claims because of OMIG’s refusal to disclose details of the procedure by which OMIG selected the allegedly random sample. As a result, OMIG was allowed to recoup only $433.06 instead of the extrapolated amount of $291,915. While many providers expressed great satisfaction with this outcome, they should look carefully at the rest of the ALJ’s decision, which completely rejected a number of other claims and excuses that health care providers frequently try to fall back on when OMIG audits uncover documentation problems.