Statutes, codes, and regulations
New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICESChapter II - Regulations of the Department of Social ServicesSubchapter E - Medical CareArticle 3 - Policies and Standards Governing Provision of Medical and Dental CarePart 521 - Fraud, Waste and Abuse Prevention
Subpart 521-3 - SELF-DISCLOSURE PROGRAM
Section 521-3.3 - Reporting and returning overpayments

N.Y. Comp. Codes R. & Regs. tit. 18 § 521-3.3

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Current through Register Vol. 46, No. 19, May 8, 2024
Section 521-3.3 - Reporting and returning overpayments
(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.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 521-3.3

Adopted New York State Register December 28, 2022/Volume XLIV, Issue 52, eff. 12/28/2022