The Office of the Inspector General (OIG), a division of the Department of Health & Human Services, last week issued the first major revision to its Provider Self-Disclosure Protocol. The protocol describes what physicians, hospitals and other members of the health care industry must report to the government in order to avoid prosecution for self-discovered fraud and to possibly receive a reduced penalty.
The Provider Self-Disclosure Protocol was created in 1998 to establish a process for physicians and health care professionals/entities to voluntarily identify, disclose and resolve instances of potential fraud involving federal health care programs. The OIG issued “Open Letters to Health Care Providers” in 2006, 2008 and 2009 with additional guidance, but the April 17, 2013, update represents the first comprehensive revision of the protocol since its creation. The updated protocol is posted on the OIG website along with a training video.
In the updated Provider Self-Disclosure Protocol, the OIG acknowledges for the first time in writing that physicians and health care professionals and entities that self-report certain types of Medicare fraud could be eligible to receive a reduced penalty of 1½ times the amount of money involved. Disclosing parties must acknowledge that the conduct is a potential violation and identify the specific laws or regulations that potentially were violated. The disclosing party also must admit that a potential violation occurred, not just that the government may view the conduct as a violation.
The Provider Self-Disclosure Protocol provides guidance on how to investigate fraud, quantify damages and report the conduct to the OIG to resolve potential monetary penalties. Self-disclosure is used by physicians, hospitals and other members of the health care industry to avoid having costly or possibly embarrassing corporate integrity agreements imposed on them and with the hope of reducing the amount of monetary penalties. There have been more than 800 reports made pursuant to the Self-Disclosure Protocol since 1998.
The Self-Disclosure Protocol is intended only for violations that involve intentional conduct on the part of the physician, health care professional or health system (fraud). Simple billing errors or civil matters that only involve, for example, the Stark law, should be reported through the Center for Medicare & Medicaid Services’ Self-Referral Disclosure Protocol (SRDP), which was established as part of implementation of the Affordable Care Act.
Back to April 25, 2013 Medigram