Provided by:  Jennifer Kirschenbaum, Esq.
July 31, 2018
Medicaid $ Audit Uptick

For those of you take HealthFirst and other insurances that may be Medicaid payors, you may have noticed a severe uptick in pre-payment review and audit activity.  It seems that the Office of Medicaid Inspector General or other high-level government enforcers such as the District Attorney are looking to protect Medicaid dollars more forcefully as of late.  There are large scale investigations related to fraud that are ongoing.  Because payment is really getting substantially tighter you have to be very very careful to make sure you adhere to all applicable documentation requirements, should you elect to participate with Medicaid.  Also, watch who you mix with and how.  Make sure any third party arrangements or vendor relationship are reviewed.   

We are continuing to hear from practices whose employees/former employees have refused to sign the MLMIC consent forms that designate the practices to receive the cash consideration payments.  Other practices have told us that they have not heard either way, and are unsure what to do next.
We asked one of our senior litigators, Robert Plosky, what these practices should do.  According to Rob, a practice in this situation must move quickly to preserve its claim to the cash consideration.  To do so, it must notify MLMIC before August 23, 2018 that it objects to the payment of cash consideration to the employee/former employee, because it (the practice) is legally entitled to receive the cash consideration.  This notification may be sent by mailed (return receipt requested) to “Medical Liability Mutual Insurance Company Two Park Avenue, Room 2500 New York, NY 10016 Attention: Conversion Coordinator” or by e-mail to:  Copies of the notification must be provided to the employee/former employee, and the notification must state that such copy was provided.  Once MLMIC receives a timely notification of objection, it will hold the cash consideration payment in escrow until the dispute as to proper entitlement is resolved.
If you find yourself in one of the situations described above, please contact Robert Plosky at  He can help you assess your situation, determine whether a notification must be sent, and, if so, help with the preparation and/or review of such notification.  We caution you against sending out notifications without checking with us first, as you may do more harm than good or even worse, waive your rights.  We are available to help.