Office of Medicaid Provider Fraud & Abuse Investigation

In December 2006, New York City entered into a Memorandum of Understanding (MOU) with the New York State Office of the Medicaid Inspector General (OMIG) and the New York State Department of Health (DOH), authorizing New York City to implement a Medicaid provider fraud and abuse project to target Medicaid fraud, waste and abuse by healthcare and other service providers. IREA created the Office of Medicaid Provider Fraud and Abuse Investigation to implement this new initiative. As part of its functions, this Office conducts audits of Medicaid providers in New York City suspected of fraud, waste or abuse in accordance with the provisions of the MOU and the concurrent goals of the Mayor and Governor to address this crucial issue.

Since its establishment in 2006, the Office of Medicaid Provider Fraud & Abuse Investigation (OMPFAI) has expanded to include two dedicated investigative units - the Prescription Drug Fraud (PDF) unit, and the Investigative Projects and False Claims (IPFC) unit. The Prescription Drug Fraud unit handles Medicaid recipient and Medicaid provider fraud cases of a criminal nature. PDF refers suspected criminal fraud cases to the OMIG and works with various law enforcement partners to develop cases for criminal prosecution. The Investigative Projects and False Claims (IPFC) unit is a data driven unit which identifies Medicaid provider targets using sophisticated analytic tools, and pursues civil remedies through referrals to the Office of Legal Affairs and Corporation Counsel of the Human Resources Administration, and to other partners, as appropriate.

Program Contacts
Investigation, Revenue and Enforcement Administration & Welfare Fraud Hotline: 212-274-5030