Laws and Regulations

The purpose of this webpage is to identify laws and regulations that relate to the New York State Office of the Medicaid Inspector General’s (OMIG) mission to enhance the integrity of the NYS Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds, while promoting high quality patient care. It also includes information on any proposed or recently adopted regulations.  

OMIG was established in Title 3 of Article 1 of the New York State Public Health Law. Implementation of OMIG’s mission involves multiple areas, including, but not limited to compliance programs and self-disclosure, prepayment reviews, audit reports, sanctions, monetary penalties, recovery of overpayments/restitution, and administrative hearings.

The cited legal authority at the links on this page do not include all relevant laws.  In addition, the text of all cited legal authority is provided by third parties who are not controlled by OMIG.  While the text of all cited legal authority is believed to be accurate, OMIG makes no assurance or representation of accuracy.

LEGISLATION

• Overview
• Legislative Summaries

REGULATIONS

REGULATORY ACTIVITY

• Proposed Rulemaking
• Recently Adopted Regulations

MEDICAID ADMINISTRATIVE LAW JUDGE DECISIONS

This section of the website summarizes bills enacted during recent Legislative Sessions amending the Social Services Law and Public Health Law. These brief descriptions of the laws are intended only to provide highlights of the legislation and should under no circumstances be used in place of the full text of the law or regarded as interpretation of legislative intent or Office of the Medicaid Inspector General policy.

Legislative Summaries

Summary of Program Integrity Related Legislation Enacted in 2019

Summary of Program Integrity Related Legislation Enacted in 2020

The Office of the Medicaid Inspector General’s regulations are found within Title 18 of the New York Codes, Rules and Regulations (NYCRR). The regulations are in Parts within Subchapter E in Chapter II of Title 18, titled Medical Care.

Section 504.3 (Duties of the Provider)

Section 504.8 (Audit and Claim Review)

Part 514 Provider Verification of Recipient Eligibility and Orders for Service

Part 515 Provider Sanctions

Part 516 Monetary Penalties

Part 517 Provider Audits

Part 518 Recovery and Withholding of Payments or Overpayments

Part 519 Provider Hearings

Part 520 Tax Refund Offset for Overpayments of Medical Assistance

Disclaimer

The links to OMIG’s regulations are hosted by Westlaw. Westlaw’s copies of the regulations are not certified copies. The official regulations are published by the Department of State. To ensure that you are viewing the most current regulations, check the New York State Register for recent rule adoptions that may not have been published by Westlaw yet.

This page provides information about proposed regulations, including those available for public comment and recently adopted regulations. This page will be updated whenever new regulations are proposed or information changes.

Proposed Regulations        

Unless otherwise noted, the comment period extends for 60 days from the date of publication in the State Register.  Address any comments to the Agency Contact.

Recently Adopted Regulations

NYS Office of the Medicaid Inspector General
Office of Counsel
800 North Pearl Street
Albany, NY 12204
(518) 473-3782
[email protected]