The New York Office of Medicaid Inspector General (OMIG) has released the Provider Self-Disclosure Guidance (the Guidance) that establishes the process for participating in its self-disclosure program. The Guidance, which replaces the New York Department of Health disclosure protocol, encourages providers to identify, disclose and return any Medicaid overpayments to OMIG. In most circumstances, self-disclosure will result in more favorable outcomes for providers, according to OMIG. While repayment amounts will be credited toward the final settlement amount, OMIG will not accept money as full and final payment for self-disclosures prior to finalizing its own investigation. According to the Guidance, disclosure is appropriate for a broad range of matters, including substantial routine errors, systematic errors, patterns of errors an d potential violations of fraud and abuse laws.
Potential benefits to providers who self-disclose include: (a) forgiveness or reduction of interest payments (for up to two years); (b) extended repayment terms; (c) waiver of penalties and/or sanctions; (d) timely resolution of the overpayment; (e) recognition of the effectiveness of the provider's compliance and a decrease in the likelihood of imposition of an OMIG corporate integrity agreement; and (f) possible preclusion of subsequently filed New York State False Claims Act qui tam actions based on the disclosed matters.
When a provider makes a disclosure it must supply OMIG with the basis for the initial disclosure, the Medicaid program rules potentially implicated, any corrective action taken and the contact information for the individual making the report on behalf of the provider. OMIG will then consult with the provider and request any additional information it requires to conduct an investigation. OMIG estimates that the disclosure process should be completed within a six-month period.