Since 2009, the Office of Medicaid Inspector General (OMIG) has offered guidance to Medicaid providers outlining participation in OMIG’s self-disclosure program for reporting, returning, and explaining New York Medicaid overpayments. However, effective April 1, 2020, New York codified provisions formally establishing a voluntary self-disclosure program, to be implemented by OMIG. These implementing regulations took effect December 28, 2022. (See 18 NYCRR 521-3.1 et seq.) In connection with this new regulatory scheme, OMIG has issued guidance, which continues to evolve. Most recently, on August 21, 2023, OMIG announced an abbreviated self-disclosure process (ASDP) for reporting and explaining Medicaid overpayments resulting from routine or transactional errors.

The New Abbreviated Self Disclosure Process

While OMIG’s self-disclosure program has been in existence for more than a decade, now, OMIG’s ASDP makes clear that voiding or adjusting claims alone does not satisfy the obligation to report and explain an identified overpayment. This stands in contrast to OMIG’s 2009 self-disclosure guidance, which expressly allowed the amount of overpayment claims to simply be voided or adjusted for “the repayment of simple, more routine occurrences of overpayments.” (See OMIG Self-Disclosure Guidance, March 12, 2009.) Voiding or adjusting allowed providers an avenue to return funds to which they were not entitled, while not having to further address or explain to OMIG the reason it received the overpayment.