On August 21, 2023, the New York State Place of work of the Medicaid Inspector Common (OMIG) introduced updates to the Medicaid overpayment self-disclosure program, which now comprises an abbreviated procedure for reporting and explaining overpayments which might be thought to be regimen or transactional in nature and feature been already voided and altered.
The OMIG self-disclosure procedure has lengthy been established to offer an street for Medicaid suppliers to file, go back and provide an explanation for Medicaid overpayments inside 60 days of figuring out the overpayment (or via the date any corresponding value file was once due) as is needed via each Federal and State regulation.[1]
Suppliers that establish a Medicaid overpayment now have two possible choices inside the OMIG self-disclosure framework according to the mistake recognized. Mistakes that require formal corrective motion plans must at all times be self-disclosed the use of the “Self-Disclosure Complete Observation,” whilst mistakes which might be extra transactional or regimen in nature and already repaid thru voids or changes is also higher fitted to the brand new “Self-Disclosure Abbreviated Observation.”[2]
For instance, overpayments as a result of any of the next must be self-disclosed the use of the Self-Disclosure Complete Observation:
- Any error that calls for a Medicaid entity/supplier to create and put into effect a proper corrective motion plan;
- Precise, doable or credible allegations of fraudulent habits via staff or others;
- Discovery of an worker at the “Excluded Supplier” record;[3]
- Documentation mistakes that led to overpayments;
- Overpayments that resulted from tool or billing techniques updates;
- Systemic billing or claiming problems;
- Overpayments that concerned multiple Medicaid entity/supplier;
- Non-claim-based Medicaid overpayments;
- Any error with really extensive financial or program affects; and
- Any example upon route via OMIG.
Examples of overpayments that are supposed to be self-disclosed the use of the brand new Self-Disclosure Abbreviated Observation, come with:
- Regimen credit score stability/coordination of advantages overpayments;
- Typographical human mistakes;
- Regimen Internet To be had Per thirty days Source of revenue (NAMI) changes (acceptable to nursing house citizens);
- Cases of lacking or erroneous authorization for services and products because of human error;
- Cases of lacking or inadequate enhance documentation because of human error;
- Irrelevant charges, procedures or price codes used because of typographical or human error; and
- Regimen recipient enrollment problems.
OMIG cautions Medicaid suppliers that voiding or adjusting claims with out additionally the use of the abbreviated self-disclosure procedure does now not fulfill the supplier’s legal responsibility to file and provide an explanation for the recognized overpayment.
If in case you have any questions in regards to the OMIG self-disclosure procedure or need help in processing an OMIG self-disclosure, please achieve out to a member of the Sheppard Mullin Healthcare Crew.
FOOTNOTES
[1] See 42 U.S.C. §1320a-7k(d); NY Social Services and products Legislation §363-d(6).
[2] The Self-Disclosure Complete Observation and the Self-Disclosure Abbreviated Observation are to be had on OMIG’s website online at: https://omig.big apple.gov/self-disclosure-submission-information-and-instructions.
[3] “Excluded Supplier” lists are maintained via each Federal and New York State executive companies. The Place of work of Inspector Common inside the U.S. Division of Well being and Human Services and products maintains a “Record of Excluded Folks/Entities”, which is compromised of people and entities which might be excluded from collaborating in Federal well being care methods (e.g., Medicare and Medicaid). See https://oig.hhs.gov/exclusions. The OMIG maintains an inventory of Medicaid suppliers who’re now not eligible to take part within the Medicaid program. See https://omig.big apple.gov/medicaid-fraud/medicaid-exclusions.
