Medicaid Self-Disclosure Guidance
The Office of the Medicaid Inspector General (OMIG) has established new “Self-Disclosure Guidance”, applicable to both local providers and state agencies, to report significant Medicaid overpayments uncovered by the providers, as part of its efforts to improve the integrity of the Medicaid program. This new guidance replaced the previous Department of Health (DOH) disclosure protocol.
Issues appropriate for disclosure may include, but are not limited to:
- Substantial routine errors;
- Systemic errors;
- Patterns of errors; and
- Potential violation of fraud and abuse laws.
OMIG is not interested in fundamentally altering the day-to-day business processes of organizations for minor or insignificant matters. Consequently, the repayment of simple, more routine occurrences of overpayment should continue through typical methods of resolution, which may include voiding or adjusting the amounts of claims.
The guidance document offers the following incentives for self-disclosure:
While the specific resolution of self-disclosures depends upon the individual merits of each case, the OMIG typically extends the following benefits to providers who, in good-faith, participate in a self-disclosure:
- Forgiveness or reduction of interest payments (for up to two years);
- Extended repayment terms;
- Waiver of penalties and/or sanctions;
- Timely resolution of the overpayment;
- Recognition of the effectiveness of the provider’s compliance and a decrease in the likelihood of imposition of an OMIG Corporate Integrity Program; and
- Possible preclusion of subsequently filed New York State False Claims Act qui tam actions based on the disclosed matters.
Self-disclosing overpayments, in most circumstances, will result in a better outcome than if OMIG staff had discovered the matter independently.
For more details and a reporting form, please visit: http://www.omig.ny.gov/data/content/blogsection/25/162/