Self-Disclosure Submission Information and Instructions

Required Forms

To meet the obligation of reporting, returning, and explaining a Medicaid overpayment within sixty (60) calendar days of identification, a Self-Disclosure Statement and Certification must be submitted to OMIG's Self-Disclosure Unit.

The Self-Disclosure Statement contains embedded links to Excel spreadsheets for reporting your data.

To document damaged, lost or destroyed records a Statement of Damaged, Lost or Destroyed Records and Certification must be submitted to OMIG’s Self-Disclosure Unit.

Submitting the Self-Disclosure

Preferred Submission Method: OMIG's Hightail Secure Uplink site

To submit a completed Self-Disclosure using OMIG's Hightail Secure Uplink site, please follow the steps below:

1. Visit OMIG’s Hightail Secure Uplink site.

2. Select and drag the completed Self-Disclosure Statement as well as any attachments (including the completed Certification, Mixed Payer Calculation form or Claim Data File) from your saved location to the Hightail uplink window or use the “ADD FROM MY COMPUTER” button on the Hightail site.

3. Include the following information in the Hightail message section:

  • Your Name
  • Your Email address
  • Message – please include the name of the entity disclosing

4. Click on the “UPLOAD” button on the Hightail site

Your form and attachments will be securely uploaded to OMIG’s Hightail Secure Uplink site. Upon successful submission of the form and attachments, you will receive a confirmation email, which will include a link to access any uploaded files and attachments.

Additional information about Hightail and HIPAA Compliance.

To submit a Self-Disclosure by mail:

Please provide a completed Self-Disclosure Statement, Certification, and include the Claims Data File on CD or another secure device.

Send to:

Office of the Medicaid Inspector General
Attention:  Self-Disclosure Unit
800 North Pearl Street
Albany, NY 12204


Please contact OMIG's Self-Disclosure Unit by email ([email protected]) or by phone (518-402-7030).