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18 NYCRR 521-3.4 — Self-Disclosure Program

New YorkregulationNew York State Office of the Medicaid Inspector General (OMIG)· effective 2022-12-28

What this rule requires your agency to do

  • 1Under the SDCA the person shall agree to repay the overpayment and interest as determined by OMIG, make any approved installment payments on time and on schedule, and implement identified corrective actions to prevent recurrence of the issues that caused the overpayment (subd. e(2)).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 2Where the person is a required provider under SubPart 521-1, the Self-Disclosure Statement shall be signed by the person's compliance officer (otherwise by the CEO, COO, a senior manager, or the sole practitioner) (subd. c(3)).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 3The person shall not provide false material information, omit material information, or attempt to defeat or evade an overpayment due; doing so, or failing to execute and return the SDCA on time, results in immediate termination from the program and may result in recovery under Part 518 and monetary penalties under Social Services Law 145-b(4) and Part 516 (subd. f).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 4As a condition of participation in the Self-Disclosure Program, the person shall apply by submitting a Self-Disclosure Statement and shall cooperate and furnish any information requested by OMIG to confirm the overpayment (subd. c(1)).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 5When OMIG requests additional information or data, the person shall respond within fifteen (15) days of the notice (extendable by OMIG for good cause); failure to respond results in the submission being deemed not accepted and returned as incomplete, terminating any tolling (subd. d(2)).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 6The Self-Disclosure Statement shall contain: an estimate of the overpayment amount with supporting calculation; a detailed explanation of the reason for the overpayment (circumstances, how discovered, date identified, calculation method, dates received, and corrective action taken); contact information; a data file in OMIG's format; any installment or interest-waiver requests; and the person's agreement to return the full overpayment plus interest if applicable (subd. c(2)).(18 NYCRR 521-3.4 — Self-Disclosure Program)
  • 7The person shall execute and return the Self-Disclosure and Compliance Agreement (SDCA) so that OMIG receives it within fifteen (15) days of the person receiving it (or such other period OMIG permits, not less than 15 days); failure terminates participation (subd. e(3)-(4)).(18 NYCRR 521-3.4 — Self-Disclosure Program)

Applies to: personal care

Sets out OMIG's Self-Disclosure Program process for reporting, returning, and explaining Medicaid overpayments — eligibility, the required content of the Self-Disclosure Statement, who must sign it (the compliance officer for required providers), response deadlines, the Self-Disclosure and Compliance Agreement (SDCA) including corrective-action commitments, and grounds for termination.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.