In 2011, the New York Office of the Medicaid Inspector General (OMIG) passed into law a measure that required home health providers who exceeded $15 million in Medicaid and/or Medicaid Managed Care reimbursements to utilize a Verification Organization (VO). A VO is an entity that analyzes data captured by Electronic Visit Verification (EVV) software to verify that services billed to Medicaid are legitimate and were provided to an eligible Medicaid beneficiary. In addition, the VO utilizes this data to prepare an assessment of each selected provider to ensure that their processes are compliant with CMS and state guidelines. This also educates organizations on how to improve their compliance processes. The diagram below provides a simplified illustration of this process:
Since the implementation of this regulation the level of fraud, waste, and abuse in the New York homecare health industry has shrunk considerably. HHAeXchange has contributed to this success as an approved VO for OMIG in New York State. Our dedicated Compliance team performs annual audits, as well as policy and procedure reviews to attest to pre-claim service compliance captured by EVV.
Our role as a VO is not only to act as an oversight body for OMIG, but as an industry leader by providing agencies the tools and education they need to monitor themselves internally; ensuring they continue to grow and comply with state laws.