On November 8, 2021, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) released a revised Provider Self-Disclosure Protocol, renamed Health Care Fraud Self-Disclosure Protocol (“SDP”). Prior to this update, the SDP had not been updated since 2013. While many of the revisions were procedural only, some of the revisions were notable, including an increase in the minimum amount required to settle fraud claims under the SDP.
Background. The SDP was established in 1998 as a mechanism for health care providers, suppliers and other persons subject to the OIG’s civil monetary penalty (“CMP”) authorities to voluntarily disclose self-discovered evidence of possible fraud implicating federal health care program funds. Benefits of the SDP include potentially minimizing costs and disruptions for the disclosing party by avoiding a government-initiated investigation and accompanying litigation, paying a lower multiplier on damages than would be required in a government-initiated investigation, and a release from the OIG’s permissive exclusion authorities without integrity agreement obligations. The OIG has a website related to the SDP with additional information, including a list of recently settled SDP submissions. The OIG reported in the revised SDP that, between 1998 and 2020, it resolved over 2,200 disclosures, resulting in recoveries of more than $870 million to the federal health care programs. Certain conduct is not eligible for the SDP, such as...
The Centers for Medicare & Medicaid Services (CMS) and its audit contractors have the authority to suspend payments to hospice care providers suspected of submitting false claims or improperly...