OMIG's Abbreviated Self-Disclosure Process: What Providers Need to Know

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced that it revised its Self-Disclosure Program Requirements to include a streamlined pathway for Medicaid providers to report, return, and explain certain Medicaid overpayments.

Historically, routine errors have been corrected through administrative voids or adjustments rather than through the formal self-disclosure process. However, OMIG’s initial guidance for regulations released in December 2022 categorized these routine errors as overpayments that require reporting through the self-disclosure process. The revised guidance responds to feedback by providing a new abbreviated self-disclosure process to self-disclose overpayments that are considered routine or transactional errors and that have already been repaid through voids or adjustments. 

Whether the full self-disclosure process or the abbreviated self-disclosure process is used, the requirement to report, return, and explain must be completed within 60 days of identifying every overpayment. Identification occurs when a Medicaid entity or provider “has or should have through the exercise of reasonable diligence, determined [receipt of] overpayment and quantified the amount of the overpayment.”¹ The process of identification includes:

• Determining why the overpayment occurred
• How the overpayment occurred
• Who or what was involved in causing the overpayment to occur
• Who was involved in discovering the overpayment
• What will be done to correct the overpayment and ensure it doesn’t reoccur
• Quantification of the overpayment amount²

Once the reason for overpayment is reviewed, the Medicaid provider can determine which process is appropriate: errors that require formal corrective action plans and that are systemic, ongoing, or both should be self-disclosed through the full self-disclosure process, and errors that are more routine or transactional in nature “may be better suited” for the abbreviated self-disclosure process.³ OMIG’s revised guidance provides examples for when the abbreviated self-disclosure process should be used, including:

• Routine credit balance/coordination of benefits overpayments
• Typographical human errors
• Routine Net Available Monthly Income (NAMI) adjustments
• Instances of a missing or faulty authorization for services due to human error
• Instances of missing or insufficient support documentation due to human error
• Inappropriate rate, procedure, or fee codes used due to typographical or human error
• Routine recipient enrollment issues

Additionally, the revised guidance sets forth the information that must be submitted when using the abbreviated self-disclosure process, which is far less detailed than for the full self-disclosure process. Providers must disclose:

• Federal Employer Identification Number (FEIN) or SSN
• Provider name or d/b/a
• Contact name, title, phone number, and email
• Overpayment identification period
• Transaction control numbers (TCNs) of voided or adjusted claim(s)
• Reason for the overpayment reflected by each voided or adjusted claim 
• Total amount voided or adjusted during the identification period

For providers that have identified an overpayment, the following abbreviated self-disclosure process should be expected:

1. Void or adjust the overpaid claims within 60 days.
2. Report and explain to OMIG using the self-disclosure abbreviated statement spreadsheet.⁴
3. Overpayments may be aggregated and submitted by the fifth day of the month following the month in which the claims were avoided or adjusted.
4. Submit using the self-disclosure abbreviated statement online form.
5. Email confirmation of submission will be received from OMIG.
6. If additional information is requested, it must be supplied to OMIG within 15 calendar days from the request.
7. OMIG’s Self-Disclosure Unit will verify that the voids or adjustments were completed successfully and review the self-disclosure to ensure no larger issues exist that need further corrective action.
8. OMIG will not issue a Determination Notice.
9. OMIG has the discretion to require submission of a full self-disclosure statement.

OMIG recommends providers aggregate their self-disclosures into a monthly report, which must be submitted by the fifth of the month following the month in which claims were voided or adjusted.⁵ OMIG expects data for routine overpayments that are corrected via voids and adjustments to be collected for the month of September 2023 and the first monthly report to be made by October 5, 2023.

Providers should note that voiding or adjusting a claim, by itself, does not satisfy the Medicaid provider’s obligation to report and explain the identified overpayment. The new regulation and guidance places an additional burden on providers. This burden essentially requires providers to track and report overpayments that they used to simply void or adjust and move on.

The new guidance also makes clear that OMIG has added authority into self-disclosures by specifically noting that it “may use disclosed information and shall pursue any civil or criminal penalty that might apply to the misconduct disclosed as part of the program process.”

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 and will continue to monitor any developments and report on best practices.

If you have any questions regarding the content of this alert, please contact Margaret Surowka, Health & Human Services Providers Team co-leader, at msurowka@barclaydamon.com; Dena DeFazio, associate, at ddefazio@barclaydamon.com; Ron Oakes, law clerk, at roakes@barclaydamon.com; or another member of the firm’s Health & Human Services Providers Team.
                                                                                         
¹NY CLS SOC SERV § 363-d(6)(b).
²OMIG, Self-Disclosure Frequently Asked Questions, Q. 2 [hereinafter OMIG FAQs], available at https://omig.ny.gov/self-disclosure-frequently-asked-questions. 
³OMIG, SELF-DISCLOSURE PROGRAM REQUIREMENTS: INSTRUCTIONS & GUIDELINES 4–5 (2023), available at https://omig.ny.gov/media/80831/download?attachment. 
⁴The Self-Disclosure Abbreviated Statement and fillable spreadsheet are available at https://omig.ny.gov/self-disclosure-submission-information-and-instructions. 
⁵OMIG FAQs, Q. 2.