HHS OIG: Proposed Changes on Health Care Providers Self Reporting Fraud

The Office of the Inspector General (OIG) for the Department of Health and Human Services (HHS) recently announced in the Federal Register that it will be revising and soliciting comments from the public on how hospitals and other providers can self-report possible healthcare fraud. 

Comments are due August 17, 2012, and should refer to file code OIG-1301-N.

Background

In 1998, OIG published the Provider Self-Disclosure Protocol (the Protocol) to establish a process for health care providers to disclose potential fraud involving the Federal health care programs.  The Protocol provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider’s liability exposure under OIG’s civil money penalty (CMP) authorities.  Over the past 14 years, OIG has resolved over 800 disclosures, resulting in recovering over $280 million to the Federal health care programs.

Through OIG’s experience in resolving Protocol matters, they have identified areas where additional guidance would be beneficial to the provider community and would improve the efficient resolution of Protocol matters.  Specifically, OIG issued three Open Letters to Health Care Providers to address some of these issues.  First, in 2006 we announced an initiative to encourage disclosure of conduct creating liability under OIG’s anti-kickback and physician self-referral law CMP authorities.

In 2008, OIG issued additional guidance and requirements for Protocol submissions to increase the efficiency of the Protocol, including new requirements for the initial submission and specific time commitments from the provider.  This Open Letter also announced the presumption of not requiring a compliance agreement as part of settling a cooperative and complete disclosure. Finally, in 2009, OIG stated that it would no longer accept disclosure of a matter into the Protocol that involved only liability under the physician self-referral law in the absence of a colorable anti-kickback violation.  OIG also announced a minimum $50,000 settlement amount for kickback-related submissions.