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18 NYCRR 521-3.3 — Reporting and Returning Overpayments (Self-Disclosure)
New YorkregulationNew York State Office of the Medicaid Inspector General (OMIG)· effective 2022-12-28
What this rule requires your agency to do
- 1An overpayment is "identified" when the person has, or should have through the exercise of reasonable diligence, determined that they received an overpayment and quantified its amount; a person who fails to exercise reasonable diligence and in fact received an overpayment is subject to enforcement action under section 521-3.7 and applicable federal and state law, including Article XIII of the State Finance Law (subd. b(2)-(3)).(18 NYCRR 521-3.3 — Reporting and Returning Overpayments (Self-Disclosure))
- 2The person shall report and return the overpayment (and interest if applicable) to the department, and explain the reasons to OMIG, by the later of sixty (60) days after the date the overpayment was identified or the date any corresponding cost report is due (subd. b(1)).(18 NYCRR 521-3.3 — Reporting and Returning Overpayments (Self-Disclosure))
- 3Any person who has received an overpayment under the MA program, directly or indirectly, shall report, return, and explain the overpayment by submitting a Self-Disclosure Statement to OMIG's Self-Disclosure Program pursuant to section 521-3.4 (subd. a).(18 NYCRR 521-3.3 — Reporting and Returning Overpayments (Self-Disclosure))
Applies to: personal care
Requires any person who received a Medicaid overpayment to report, return, and explain it via a Self-Disclosure Statement to OMIG by the later of 60 days after the overpayment is identified or the date a corresponding cost report is due, defines when an overpayment is "identified" (reasonable diligence standard), and provides that failure to exercise reasonable diligence subjects the person to enforcement.
Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.