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OIG updates the Self-Disclosure Protocol...what you need to know

Posted by Margaret Scavotto, JD, CHC on 5/9/13 2:00 PM

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On April 17, 2013, the Office of Inspector General (OIG) updated the Provider Self-Disclosure Protocol (SDP). This update replaces prior OIG guidance on the SDP.

What is the Self-Disclosure Protocol?

The SDP is a way for providers to voluntarily disclose potential health care fraud to the OIG. The SDP can be used to report potential violations of any Federal law for which civil monetary penalties may be imposed. The SDP is not used for overpayments or errors, which should be refunded to CMS or the contractor involved.

What are the benefits of self-disclosing?

By cooperating with the OIG and self-disclosing, providers often receive a less stringent settlement and lower damages, and can receive a quicker resolution of the potential violation. The OIG is also less likely to require a corporate integrity agreement (CIA) in SDP cases.

Highlights of the updated SDP

 The updated SDP guidance:

  • Requires the disclosing party to acknowledge that the disclosed conduct is a potential violation of Federal law
  • Lists requirements for disclosure submissions
  • Includes a link providers can use to disclose via the OIG website
  • Describes specific disclosure requirements for 1) Conduct involving false billing; 2) Conduct involving excluded persons; and 3) Conduct involving the Anti-Kickback and Physician Self-Referral Laws
  • Sets forth minimum settlement amounts for SDP disclosures: $50,000 for kickbacks, and $10,000 for all other matters

What should a provider do if facing a potential self-disclosure?

Providers who become aware of a potential violation of the law involving a Federal health care program should review the OIG guidance on the SDP, and contact their attorneys to determine how to proceed.

What this means for all providers

The OIG encourages use of the SDP because it believes "good faith disclosure of potential fraud and cooperation with OIG's review and resolution process are typically indications of a robust and effective compliance program." OIG's April 17, 2013 notice updating the SDP, page 2. An effective compliance program can help you identify instances of non-compliance that are eligible for the Self-Disclosure Protocol-and reduce your damages.

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