Medicaid Audits Creating Confusion

AMS is currently addressing several complaints about audits being performed by the Arkansas Office of Medicaid Inspector General (OMIG). OMIG is a separate agency from DHS and acts independently to address Medicaid fraud, waste and abuse. AMS has received several complaints over the past month about OMIG audits resulting in recoupments from clinics over issues that appear to be in conflict with current Medicaid policy.

For example, Medicaid policy allows physicians to bill under their own Medicaid number when services are performed by APRNs or PAs “under supervision.” Based on OMIG’s interpretation, the practice would be required to bill under the APRN’s provider number resulting in reduced reimbursement for the practice. AMS staff and legislators met this past week with representatives from OMIG and DHS and are attempting to resolve these issues. Stay tuned and in the meantime, if you receive an audit request for recoupment from OMIG that you believe is in error, please contact the AMS