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2023 Guidance for the Disclosing of Medicaid Overpayments Talk to a Health Care Attorney to Discuss Your Options!

On Behalf of | Oct 6, 2023 | Firm News, Healthcare Transactions

As a New York healthcare provider rendering and billing for services to Medicaid beneficiaries, you are required to report, return, and explain any overpayment within sixty days from when a Medicaid fund overpayment was received.

Recently, the New York State Office of the Medicaid Inspector General updated its Self-Disclosure Program to include two (2) pathways for providers to disclose, among other things, the overpayment itself and to identify the reason(s) the overpayment occurred.

A provider must now determine whether the new Abbreviated Self-Disclosure Process (“ASDP”) or the existing Full Self-Disclosure Process (“FSDP”) is appropriate for reporting the overpayment to OMIG.

The FSDP should be used with errors substantial enough for Medicaid to require provider to implement a formal Corrective Action Plan, actual, potential or credible allegations of fraudulent conduct by employees, discovery of an employee whose name appears on the List of Excluded Individuals and Entities (“LEIE”) or documentation errors that resulted in an overpayment, to name a few.

The new ADSP may be used to disclose overpayments resulting from routine claims adjustments, typographical errors and other forms of human error. To submit a disclosure under the ADSP, a provider should complete the Self-Disclosure Abbreviated Statement, which may be found annexed to the OMIG Self-Disclosure Program Requirements, Instructions and Guidelines, August 2023 document.

While OMIG has seemingly simplified the Self-Disclosure process, failure to participate or report the correct information may result in the imposition of monetary penalties which are prescribed under the Social Services Law.

How you handle the reporting of Medicaid overpayments can have profound effects on your ability to service and bill Medicaid beneficiaries, so obtaining assistance from a qualified and experienced health law attorney is essential from the beginning. For questions or to schedule a consultation, you may contact any of the health care attorneys at Weiss Zarett Brofman Sonnenklar & Levy, P.C.