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State Medicaid Agency publishes self-disclosure guidance

Healthcare Auditing Weekly, March 17, 2009

On March 12, the New York State Office of Medicaid Inspector General (OMIG) released Provider Self-Disclosure Guidance, which establishes the process for participating in the OMIG’s self-disclosure program

In the document, the state said this guidance replaces the existing Department of Health disclosure protocol. 

Forming a partnership with providers through a self-disclosure approach will enhance the OMIG’s effort to detect potential fraud, waste, and abuse within the state’s Medicaid program, and also offer providers a way to reduce their legal and financial exposure, according to the guidance.

Self-disclosure typically yields a better outcome for providers than if the OMIG staff discovers a violation through investigation. According to the guidance, the OMIG typically extends the following benefits to providers who, in good-faith, participate in a self-disclosure:

• Forgiveness or reduction of interest payments (for up to two years)
• Extended repayment terms
• Waiver of penalties and/or sanctions
• Timely resolution of the overpayment
• Recognition of the effectiveness of the provider’s compliance and a decrease in the likelihood of imposition of an OMIG corporate integrity program
• Possible preclusion of subsequently-filed New York State False Claims Act qui tam actions based on the disclosed matters

The guidance also gives providers direction about when to disclose, what the process entails, what the OMIG will expect from the provider, and how providers can repay OMIG once auditors have reviewed the matter.

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