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Fidelis Care would like to inform providers of Medicaid requirements when medical records are lost due to an unforeseen event.  Providers whose records have been damaged, lost, or destroyed are required to report that information as soon as practicable, but no later than thirty calendar days after discovery, to the New York State (NYS) Office of the Medicaid Inspector General (OMIG) Self-Disclosure Unit. Failure to report such incidents may result in a determination of overpayment, penalties, and/or sanctions.

Please note: Loss/destruction/ corruption/inaccessibility of electronic records due to data corruption, theft, change in data vendor or other issues must also be included in this reporting requirement to ensure compliance with regulatory standards.

Providers are required to maintain reasonable and appropriate administrative, technical, and physical safeguards for protecting electronic health records, and should have a secure backup system in place to allow recovery of documentation destroyed or lost due to such events or any other cause. This guidance supersedes communication shared in the Update and Reminder: Medicaid Policy Loss of Records Due to Unforeseen Event article published in the November 2023 issue of the Medicaid Update.

How to Self-Report Damaged, Lost or Destroyed Records

To self-report, providers must complete the Statement of Damaged, Lost or Destroyed Records form, located on the NYS OMIG Self-Disclosure "Lost, Damaged or Destroyed Records Reporting" web page. The NYS OMIG Self-Disclosure "Lost, Damaged or Destroyed Records Reporting" web page, additionally offers the NYS OMIG Hightail Secure Uplink website, for form submission and all required supporting documentation.

As stated in Title 18 of the New York Codes Rules and Regulations (NYCRR) §504.3,  "by enrolling in the Medicaid program, the provider agrees:

(a) to prepare and to maintain contemporaneous records demonstrating its right to receive payment under the medical assistance program and to keep for a period of six years from the date the care, services or supplies were furnished, all records necessary to disclose the nature and extent of services furnished and all information regarding claims for payment submitted by, or on behalf of, the provider and to furnish such records and information, upon request, to the department, the Secretary of the United States Department of Health and Human Services, the Deputy Attorney General for Medicaid Fraud Control and the New York State Department of Health; …(i) to comply with the rules, regulations and official directives of the department."

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist. Thank you for being a valued Fidelis Care partner in the provision of quality care.