Self-Disclosure

Self-Disclosure of Medicaid Overpayments

The New York State Office of Medicaid Inspector General (OMIG) developed the Self-Disclosure Program in consultation with health care providers and industry professionals to give providers an easy-to-use method for disclosing overpayments. OMIG designed this approach to encourage providers to investigate and report matters that involve possible fraud, waste, abuse or inappropriate payment of funds that they identify through self-review, compliance programs, or internal controls that affect the state’s Medicaid program.

Providers must submit self-disclosures and reports of damaged, lost or destroyed records to OMIG’s Self-Disclosure Unit. Please see the following links for additional information:

Regulatory Authority

Failure to timely report and return any Medicaid overpayment can have severe consequences, including potential liability under the False Claims Act, the imposition of civil monetary penalties, fines and treble damages, as well as exclusion from the Medicare and Medicaid programs.

OMIG’s Self-Disclosure Program is in accordance with OMIG’s enabling legislation.

  • New York State Public Health Law (NYS PHL) §32(18) states OMIG shall, in conjunction with the commissioner, develop protocols to facilitate the efficient self-disclosure and collection of overpayments and monitor such collections, including those that are self-disclosed by providers. The provider's good faith self-disclosure of overpayments may be considered as a mitigating factor in the determination of an administrative enforcement action.
  • Affordable Care Act (ACA) of 2010 §6402 states that Medicaid and Medicare overpayments must be returned within 60 days of identification, or by the date any correspondence cost report was due, whichever is later.
  • Title 18 of the New York Code of Rules and Regulations (NYCRR) §521-3 establishes the requirements that persons shall report, return and explain overpayments to the Medicaid inspector general, and explains the requirements of the self-disclosure program administered by OMIG. 
  • Title 42 of the United States Code (USC) §1320a-7k(d)(1) & (2) requires a person who has received an overpayment to report the overpayment, the reason for the overpayment, and to return the overpayment within 60 days of identification or by the date the corresponding cost report is due, if applicable.
  • Social Services Law (SOS) §363-d(6) & (7) requires a person to report and return overpayments under the medical assistance program to the Medicaid inspector general within 60 days of identification, or by the date any corresponding cost report is due, if applicable.  It also outlines eligibility criteria for participation in the self-disclosure program and overpayment report processing timeframes.
  • Social Services Law (SOS) §145-b(4)(D)(iii) states that payment of monetary penalties may be required in restitution to the medical assistance program for any person who knew or should have known that an overpayment was identified and was not reported, returned and explained in accordance with SOS §363-d.