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Kirti Reddy and Theresa DeAngelis Author New York Law Journal Article on Evolving State Changes Guiding Medicaid Overpayment Self-Disclosure


Quarles & Brady Health & Life Sciences attorneys Kirti Reddy and Theresa DeAngelis wrote an article for the New York Law Journal about implications for Medicaid providers of the latest state-level changes regarding self-disclosure of overpayment.

Reddy, a partner, and DeAngelis, an associate – both based in the firm’s Washington, D.C., office – outlined how evolving guidance from the Office of Medicaid Inspector General (OMIG) affects providers in New York and steps providers need to consider to remain compliant when disclosing Medicaid overpayments.

An excerpt from the article:

Tracking the language of the federal provisions, the New York provisions require Medicaid providers who have received an overpayment to report, return and explain the overpayments to OMIG within the later of (1) 60 days after the date on which the overpayment was identified, or (2) the date any corresponding cost report is due, if applicable.

Drawing from CMS final rules relating to when an overpayment is identified for purposes of triggering the 60-day timeframe to report and return, New York codified a “reasonable diligence” standard for identification of overpayments.

Ultimately, OMIG’s self-disclosure process encourages providers to review their billings, maintain an effective compliance program, and return any overpayments. While OMIG’s guidance on the new ASDP may yet evolve, for now, providers must be vigilant, familiarize themselves with the ASDP and ensure that even overpayments resulting from routine or transactional errors are disclosed.

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