Looking For Fraud in all The Wrong Places By Gregory Naclerio

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In the 1974 movie, Return of the Pink Panther, Inspector Jacques Clouseau interrogates a beggar playing an accordion in front of a bank. Clouseau informs the beggar that “City Ordinance 147-B prohibits the playing of any musical instrument in a public place for the purpose of commercial enterprise without a proper license.” As the beggar and Clouseau debate whether the beggar and his “minkey” are engaged in a “commercial enterprise,” four masked men in the background rob the bank. Many Medicaid providers believe the Office of Medicaid Inspector General (OMIG) is guilty of the same myopic view when it comes to finding fraud.

We are all aware of the state budget woes and the need for OMIG to meet federally set benchmarks to hold onto the $1.5 billion the federal government gave the state for health reform initiatives, also known as “F-Sharp.” To date, OMIG has met its F-Sharp goals and is on track to surpass its September 30, 2010 goal of $429 million in recoveries. For that, OMIG is to be commended. But on closer inspection, is the OMIG really fighting fraud?

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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