On August 21, 2023, the New York State Workplace of the Medicaid Inspector Common (OMIG) introduced updates to the Medicaid overpayment self-disclosure program, which now contains an abbreviated course of for reporting and explaining overpayments which are thought of routine or transactional in nature and have been already voided and adjusted.

The OMIG self-disclosure course of has lengthy been established to offer an avenue for Medicaid suppliers to report, return and clarify Medicaid overpayments inside 60 days of figuring out the overpayment (or by the date any corresponding value report was due) as is required by each Federal and State legislation.[1]

Suppliers that determine a Medicaid overpayment now have two decisions inside the OMIG self-disclosure framework primarily based on the error recognized. Errors that require formal corrective motion plans ought to at all times be self-disclosed utilizing the “Self-Disclosure Full Assertion,” whereas errors which are extra transactional or routine in nature and already repaid by means of voids or changes could also be higher suited to the brand new “Self-Disclosure Abbreviated Assertion.”[2]

For instance, overpayments ensuing from any of the next must be self-disclosed utilizing the Self-Disclosure Full Assertion:

• Any error that requires a Medicaid entity/supplier to create and implement a proper corrective motion plan;
• Precise, potential or credible allegations of fraudulent habits by staff or others;
• Discovery of an worker on the “Excluded Supplier” record;[3]
• Documentation errors that resulted in overpayments;
• Overpayments that resulted from software program or billing programs updates;
• Systemic billing or claiming points;
• Overpayments that concerned multiple Medicaid entity/supplier;
• Non-claim-based Medicaid overpayments;
• Any error with substantial financial or program impacts; and
• Any occasion upon course by OMIG.

Examples of overpayments that must be self-disclosed utilizing the brand new Self-Disclosure Abbreviated Assertion, embody:

• Routine credit score steadiness/coordination of advantages overpayments;
• Typographical human errors;
• Routine Internet Out there Month-to-month Earnings (NAMI) changes (relevant to nursing dwelling residents);
• Cases of lacking or defective authorization for companies because of human error;
• Cases of lacking or inadequate help documentation because of human error;
• Inappropriate charges, procedures or price codes used because of typographical or human error; and
• Routine recipient enrollment points.

OMIG cautions Medicaid suppliers that voiding or adjusting claims with out additionally utilizing the abbreviated self-disclosure course of doesn’t fulfill the supplier’s obligation to report and clarify the recognized overpayment.

If in case you have any questions concerning the OMIG self-disclosure course of or want help in processing an OMIG self-disclosure, please attain out to a member of the Sheppard Mullin Healthcare Group.

FOOTNOTES

[1] See 42 U.S.C. §1320a-7k(d); NY Social Companies Legislation §363-d(6).

[2] The Self-Disclosure Full Assertion and the Self-Disclosure Abbreviated Assertion can be found on OMIG’s web site at: https://omig.ny.gov/self-disclosure-submission-information-and-instructions.

[3] “Excluded Supplier” lists are maintained by each Federal and New York State authorities companies. The Workplace of Inspector Common inside the U.S. Division of Well being and Human Companies maintains a “Record of Excluded People/Entities”, which is compromised of people and entities which are excluded from taking part in Federal well being care packages (e.g., Medicare and Medicaid). See https://oig.hhs.gov/exclusions. The OMIG maintains a listing of Medicaid suppliers who’re now not eligible to take part within the Medicaid program. See https://omig.ny.gov/medicaid-fraud/medicaid-exclusions.