HHS: Self-disclosure saves providers money in cases of Medicare and Medicaid fraud

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HHS Inspector General Daniel Levinson
HHS Inspector General Daniel Levinson

Long-term care providers who self-disclose potential Medicare and Medicaid fraud will likely benefit from lower repayment amounts, according to updated guidance released Wednesday.

The latest update marks the fourth time that the Department of Health and Human Services Office of Inspector General has revised the Self-Disclosure Protocol (SDP) since it was established in 1998. It is the first time the agency has explicitly acknowledged systematically imposing lower penalties for self-reported fraud.

“We believe that individuals or entities that use the SDP and cooperate with OIG during the SDP process deserve to pay a lower multiplier in single damages than would normally be required in resolving a government-initiated investigation,” the new protocol states.

As a general practice, OIG requires a minimum multiplier of 1.5 times the single damages, but the agency may use a higher multiplier depending on the circumstances of a case, according to the updated guidelines.

Providers who self-disclose fraud generally do not have to submit to corporate integrity agreements as part of a settlement with OIG. Since 1998, only one SDP settlement out of 235 has involved an integrity agreement, OIG stated in the protocol.

The agency also changed the timeframe in which self-reporting providers must submit findings from an internal investigation and a calculation of damages. Previously, providers had 90 days from the time of acceptance into SDP, and they now have 90 days from the date of submission.

The new protocol lists the specific requirements for all self-disclosures, with sections devoted to cases of false billing, anti-kickback violations and conduct of persons excluded from federal health programs. The document also stresses that the SDP is meant only for resolving cases of law-breaking, and is not a way to report errors or non-fraudulent overpayments.

An online form for self-disclosures will be available soon, according to the OIG.

Click here to view the updated protocol.