Laws and Regulations


The New York State Office of the Medicaid Inspector General was created by Chapter 442 of the Laws of 2006. For more information on the laws and regulations pertinent to OMIG, visit the Laws database.

New York State Law
Executive Law § 835 Definitions
State Finance Law § 190 Civil actions for false claims
Tax Law § 697 General powers of tax commission
Public Health Law § 30 Legislative intent
Public Health Law § 30-A Definitions
Public Health Law § 31 Establishment of the office of Medicaid inspector general
Public Health Law § 32 Functions, duties and responsibilities
Social Services Law § 2 Definitions
Social Services Law § 145-B False statements; actions for treble damages
Social Services Law § 363-D Provider compliance program
Social Services Law § 363-E*2 Preclaim review for participating providers
Social Services Law § 365-J Advisory opinions
Social Services Law § 366-A Applications for assistance; investigations; reconsideration
Social Services Law § 367-B Medical assistance information and payment system
Social Services Law § 493 Abuse and neglect findings; consequences
New York Codes, Rules and Regulations
Executive Section 5.140
Executive Section 5.140.1
Executive Section 7.31
Health Section 86-2.40
Mental Hygiene Section 599.15
Social Services Section 360-10.3
Social Services Section 518.9
Social Services Section 521.3
Social Services Section 521.4
Proposed Regulations and Rule Review

Proposed amendments to 18 NYCRR Part 516 – Monetary Penalties

Adopted amendments to 18 NYCRR Part 516 – Monetary Penalties

2018 Regulatory Agenda


Pursuant to State Administrative Procedure Act (SAPA) § 202-d, the Office of the Medicaid Inspector General (“OMIG”) presents its regulatory agenda. The following regulations are under consideration by OMIG for submission as Notices of Proposed Rulemaking in 2018. All sections and parts refer to Title 18 of the New York Code of Rules and Regulations. OMIG reserves the right to add, delete or modify, without further notice, except as required by SAPA, any item or information presented herein relating to the 2018 Regulatory Agenda.

Below is a brief description of the regulations, by subject matter, that are under review by OMIG:

Regulation  Amend description 
515.1 Scope and Definitions Amend to add new or clarify existing definitions.
515.2 Unacceptable Practices Amend to identify new or clarify existing unacceptable practices under the medical assistance program.
515.3 Authority to Sanction Amend to clarify authority to sanction affiliates.
515.5 Sanctions; Effect Amend to consolidate sanction definitions and to clarify the effect of each sanction.
515.7 Immediate Sanctions Amend to clarify existing guidelines for immediate sanctions.
515.8 Mandatory Exclusions Amend to clarify new and existing guidelines for mandatory exclusions.
516.1 Policy, Scope and Definitions Amend to specify the standards of the medical assistance program and the basis for monetary penalties.
516.4 Notification and Hearings Amend to clarify notification procedures.
516.5 Effect and Enforcement of the Penalty Amend to clarify the authority to sanction and recover overpayments in relation to monetary penalties.
517.3 Audit and Record Retention Amend to update audit and record retention requirements.
518.2 Definitions Amend to include definition of a credible allegation of fraud.
518.3 Liability for Overpayments Amend to clarify joint and several liability for overpayments.
518.5 Recovery of Overpayments, Procedure Amend to clarify the procedures for recovering overpayments.
518.6 Recoupment of Overpayments Amend to identify overpayment recoupment authority and procedure.
518.7 Withholding of Payments Amend to clarify the guidelines and procedures for withholding payments.
518.8 Recovery of Overpayments Pending a Hearing Amend to clarify the procedures for the recovery of overpayments pending a hearing.
519.4 Right to a Hearing Amend to clarify the situations in which a person is or is not entitled to a hearing.
519.7 Request for a Hearing Amend to clarify mailing address and procedures for hearing requests.
Part 521 Provider Compliance Programs Amend to specify and clarify the requirements of provider compliance programs.
Contact Person

NYS Office of the Medicaid Inspector General

Michael T. D'Allaird, Esq.

Associate Attorney

800 North Pearl Street

Albany, NY 12204

(518) 408-5803

[email protected]