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Home Health Care Audit and Recovery Specialist

Active

State & Local

Response Deadline11/06/2026, 05:00:00 AM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

AI Contract Overview

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The Home Health Care Audit and Recovery Specialist subcontract supports the New York State Office of the Medicaid Inspector General by auditing home health providers to detect non-compliance with Medicare demand billing. The primary objective is to execute recovery operations that ensure Medicare-reimbursed funds are returned to the state while enhancing the overall accuracy of the reconciliation process. Qualified candidates must hold CFE or CPC certifications to perform these duties. Key deliverables for the contract include the submission of detailed audit reports, the identification of specific overpayments, and the successful recovery of funds. The solicitation was posted on October 16, 2026, with a response deadline of November 6, 2026.

General Info

Audit home health providers for NY Medicaid to detect non-compliance and recover funds.

Agency

New York → NYS Office of Medicaid Inspector General

NAICS

561440 - Collection Agencies

Place of Performance

NY, USA

Set-Aside

NONE

Documents

This scope was carved out of 2140006.

The full solicitation package (2 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

RFP# OMIG 26-23- Home Health Care Medicare Maximization Services (HHC MMX)

AI Contract Breakdown

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Timeline

PostedOct 16

subcontract

Response DeadlineNov 6

Submission deadline

Response Deadline

11/06/2026, 05:00:00 AM UTCin 17 days

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Organization & Contact Information

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AgencyNew York → NYS Office of Medicaid Inspector General

ContactsNo contacts available

OfficeN/A

Organization / AgencyNew York → NYS Office of Medicaid Inspector General

Office AddressN/A

ContactsNo contact information available

Full Description

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Conducts audits of home health providers for prime contractors on NYS Office of the Medicaid Inspector General (OMIG) projects to identify non-compliance with Medicare demand billing. Executes recovery operations to ensure providers return Medicare-reimbursed amounts to NYS and improves reconciliation accuracy. Requires CFE or CPC certifications. Delivers audit reports, identified overpayments, and recovered funds.

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RFP# OMIG 26-23- Home Health Care Medicare Maximization Services (HHC MMX)

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The New York State Office of the Medicaid Inspector General (OMIG) is soliciting proposals for the Home Health Care Medicare Maximization Services (HHC MMX) program. The primary objective of this initiative is to ensure Medicaid remains the payer of last resort by maximizing Medicare coverage for dual-eligible recipients receiving home health services. The selected contractor will be responsible for a comprehensive range of activities, including data analysis for case selection, performing medical and legal reviews, filing and tracking appeals through the Medicare Administrative Appeals Process, and coordinating with providers to recover overpayments. Additionally, the contractor will provide provider education to improve demand billing compliance and maintain rigorous reporting and audit documentation. The resulting contract is intended to be effective July 1, 2027, for an initial term of three years with two optional one-year extensions. Compensation is structured as a contingency fee percentage of gross Medicare recoveries. To ensure high-quality performance, the contractor must employ a qualified team including a Program Director, a full-time Program Manager, registered nurses, and at least one attorney licensed in New York State. Strict compliance requirements are in place, including a mandate that all work be performed and data stored exclusively within the United States, as well as significant insurance requirements, most notably a 10 million dollar cyber liability limit. Award decisions will be based on best value, evaluating organizational experience, technical expertise in Medicare appeals, and the proposed operational innovations.

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