On September 28, 2023, the New York State Office of Mental Health (OMH) released the Self-Disclosure Notification Protocol, which requires providers who are licensed, certified, designated, or funded (either directly or indirectly) by the OMH to notify the agency when they make certain self-disclosures of Medicaid overpayments to the Office of the Medicaid Inspector General (OMIG).
Medicaid providers are required to report, return, and explain any overpayments they have received to the OMIG Self-Disclosure Program within 60 days of identification or by the date any corresponding cost report was due, whichever is later. OMIG’s revised Self-Disclosure Program Requirements, released in August 2023, provide guidance on the agency’s full self-disclosure process and introduced an abbreviated self-disclosure process. OMH’s protocol requires notification only when providers submit a self-disclosure using the full self-disclosure process. Providers should note an exception to this new requirement; if the overpayment is already encompassed by an existing OMIG review, notification is not required.
The determination of whether the full or abbreviated process is warranted should be based on the error identified. For errors that require formal corrective action plans, the full self-disclosure process must be followed. However, for overpayments considered routine or transactional errors and that have already been repaid through voids or adjustments, the abbreviated process may be used. To learn more about OMIG’s abbreviated self-disclosure process, please see our alert on the topic.
OMH Notification Process
When a provider submits a self-disclosure using the self-disclosure full statement, notification must be made to the provider’s OMH local field office representative and the OMH Medicaid Compliance Office at compliance@omh.ny.gov. The notification must include:
- The date of determination of the overpayment
- The scope of the claims paid (i.e., date range of claims and amount of total overpayment)
- The affected site, program, or both
- An explanation of the cause of the overpayment
- All corrective actions implemented to prevent further overpayments
Once notified, the OMH Medicaid Compliance Office will review and issue a statement confirming that the oversight agency has been notified.
It appears that the OMH process is a notification process only; that is, OMH does not intend to investigate the self-disclosure. Nevertheless, providers should be mindful that OMH has jurisdiction over its licensed agencies and could use the information it receives in any of its own oversight functions. Barclay Damon will be monitoring any developments.
Additionally, providers should note that the Self-Disclosure Notification Protocol is not yet posted to the OMH website. However, the OMH is in the process of redesigning its Medicaid Compliance webpage and plans to include the protocol when completed.
Attorneys on Barclay Damon’s Health & Human Services Providers Team are available to assist with reviewing and revising corporate compliance self-disclosure policies and procedures, effectiveness reviews, internal investigations, and submission of self-disclosures. We will continue to monitor any developments and report on best practices.
If you have any questions about the content of this alert, please contact Margaret Surowka or Melissa Zambri, Health & Human Services Providers Team co-leaders, at msurowka@barclaydamon.com and mzambri@barclaydamon.com; Ron Oakes, law clerk, at roakes@barclaydamon.com; or another member of the firm’s Health & Human Services Providers Team.