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New York Medicaid Providers Now Have Two Pathways to Self-Disclose Overpayments to the Office of the Medicaid Inspector General

Healthcare Law Blog

On August 21, 2023, the New York State Office of the Medicaid Inspector General (OMIG) announced updates to the Medicaid overpayment self-disclosure program, which now includes an abbreviated process for reporting and explaining overpayments that are considered routine or transactional in nature and have been already voided and adjusted.

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Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

Healthcare Law Today

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.


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Attention New York Medicaid Providers: It’s Time to Upgrade Your Compliance Program

Healthcare Law Blog

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

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New York State OMIG Makes Regulatory Modifications to Compliance Program Requirements

Health Law Advisor

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. Part 521, make several important changes that will affect all Medicaid Providers’ compliance programs throughout New York State. New York Social Services Law § 363-d. The final regulations, codified at 18 N.Y.C.R.R.

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The Trebling Effect of (Some) False Claims Act Trials

Health Law RX

Setting aside the incalculable impact that litigation can have on business operations, the statute itself anticipates repayment of the proven overpayment, treble damages, and exposure to a civil statutory penalty equal to a range between $13,508 and $27,018 per false claim. This is the reality for a medical company in Minnesota.

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Closing Care Gaps Through Prospective Risk Adjustment

HIT Consultant

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 million (net) and $4.7 billion from 2023 through 2032, including extrapolation effects.

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Compliance Risks Associated with Outlier Payments 


Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. Allegedly, the facility also failed to fully reimburse the government for its receipt of these outlier payments after it became aware of the issue. Return illegitimate reimbursement and overpayments quickly.