Federal & State Regulations
OMIG Posts Comprehensive Guidance on Compliance Programs, Self-Disclosure, and Medicaid Managed Care Fraud, Waste and Abuse Prevention Programs Regulations
January 31, 2023
The New York State Office of the Medicaid Inspector General (OMIG) has adopted new regulations expanding requirements governing compliance programs; strengthening Medicaid managed care plan fraud, waste, and abuse prevention programs; and codifying OMIG’s self-disclosure program for Medicaid overpayments. Click link to view:
Compliance Library | Office of the Medicaid Inspector General (ny.gov)
Self-Referral Disclosure Protocol
Patient Protection and Affordable Care Act:
Section 6409 of the Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010. Section 6409(a) of the ACA required the Secretary of the Department of Health and Human Services, in cooperation with the Inspector General of the Department of Health and Human Services, to establish a Medicare self-referral disclosure protocol that sets forth a process to enable providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute.
CMS Self-Referral Disclosure Protocol
Medicare Overpayments
An overpayment is a payment made by CMS to a provider that exceeds the amount due and payable according to existing laws and regulations. Identified overpayments are debts owed to the federal government. Laws and regulations require that CMS recover overpayments. Click link to view MLN Overpayment Fact Sheet: