AANEM News Express

AANEM News Express

Provider Self-Disclosure Protocols Clarified by OIG

5/31/2013
 
Provider Self-Disclosure Protocols Clarified by OIGNewly revised Provider Self-Disclosure Protocol from the Office of the Inspector General (OIG) aims to create a more transparent process for reporting potential fraud, define physician expectations, and instruct providers on how to reach a successful resolution with the OIG. The OIG made revisions following solicitation of comments from the public and health care community last year.

In 1998, the OIG first published the protocol, which established a process to allow health care providers to voluntarily identify and disclose potential fraud. Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a government-directed investigation and civil or administrative litigation. Since 1998, this program has returned over $280 million to federal health care programs. Various revisions to this program were made in 2006, 2008, and 2009.

In its April report, the OIG states that individuals or entities that use the self-disclosure protocols and cooperate with the OIG should pay a lower multiplier on damages than would normally be applied under a government-initiated investigation. In these cases, they indicate they will generally impose a 1.5 multiplier against the damages, while reserving the right to change this based on individual circumstances. In addition, the report gives further clarification on disclosing the more common types of fraud reported to the OIG – false billing, employing individuals on the OIG list of excluded individuals and entities, and potential violations of the anti-kickback statute and physician self-referral law.

More information, including the full report, can be found here.
 


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