New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 521 - Fraud, Waste and Abuse Prevention
Subpart 521-3 - SELF-DISCLOSURE PROGRAM
Section 521-3.3 - Reporting and returning overpayments
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 521-3.3
Current through Register Vol. 46, No. 39, September 25, 2024
(a) General. Any person who has received an overpayment under the MA program, directly or indirectly, shall report, return and explain the overpayment by submission of a Self-Disclosure Statement to OMIG's Self-Disclosure Program pursuant to section 521-3.4 of this SubPart.
(b) Deadline for reporting and returning overpayments.
(1) If a person has received an
overpayment under the MA program, the person shall report and return the
overpayment and interest if applicable to the department, and explain the
reasons for the overpayment to OMIG by the later of:
(i) the date which is sixty (60) days after
the date on which the overpayment was identified; or
(ii) the date any corresponding cost report
is due, if applicable.
(2) Pursuant to paragraph (b) of subdivision
6 of section 363-d of
the Social Services Law, a person has identified an overpayment when that
person has or should have through the exercise of reasonable diligence,
determined that they have received an overpayment and quantified the amount of
the overpayment.
(3) Where a person
fails to exercise reasonable diligence, and the person in fact received an
overpayment, they shall be subject to any enforcement action authorized by
section 521-3.7 of this SubPart and any
applicable provisions of federal and state law, including but not limited to
Article XIII of the New York State Finance Law.
(4) Pursuant to paragraph (c) of subdivision
6 of section 363-d of
the Social Services Law, the deadline for reporting, returning and explaining
an overpayment shall be tolled when OMIG acknowledges receipt of a submission
of a Self-Disclosure Statement to its Self-Disclosure Program pursuant to
section 521-3.4 of this SubPart, and shall
remain tolled until such time:
(i) that an
SDCA, in accordance with subdivision (e) of section
521-3.4 of this SubPart, is
executed by both the person reporting, returning and explaining the overpayment
and OMIG, if applicable;
(ii) the
person withdraws from the Self-Disclosure Program;
(iii) the person repays the full amount of
the overpayment along with any interest due, as determined by OMIG after review
of a person's disclosure, in accordance with the provisions of section
521-3.5 of this SubPart;
or
(iv) OMIG terminates, pursuant
to subdivision (f) of section
521-3.4 of this SubPart, the
person's participation in the Self-Disclosure Program.
(5) For an overpayment made by an MMCO to the
person under the MA program. A person who reports, returns and explains an
overpayment to an MMCO, in accordance with the provisions of subdivision (f) of
section 521-2.4 of this Part shall be
considered to have satisfied the requirements of subdivision 6 of section 363-d of
the Social Services Law, provided that the overpayment is reported and returned
to the MMCO by the deadline specified in paragraph (1) of this
subdivision.
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