OIG Releases Updated Self-Disclosure Protocol

The Office of Inspector General (OIG) released an updated provider self-disclosure protocol (SDP) last week, which replaces the original SDP issued in 1998 and various OIG Open Letters that provided additional guidance on the program. The OIG outlined what it considers to be some significant benefits to disclosing potential fraud through the SDP:

  1. The OIG explained that it has “instituted a presumption against requiring integrity agreement obligations,” which can be very expensive for providers to implement.
  2. The OIG explained that its general practice is to require a minimum multiplier of 1.5 times the single damages at issue even though under the CMP law the OIG may assess up to 3 times the single damages.
  3. The OIG discussed the overpayment rule proposed by CMS last year and noted that the time for repayment of an identified overpayment will be tolled for the disclosing party.

Health care providers are eligible to use the SDP to resolve liability arising from the potential violation of federal criminal, civil, or administrative laws for which CMPs are authorized, but matters involving simple overpayments or errors as well as matters involving potential liability under the Stark law only are not eligible for resolution through the SDP (Stark law matters should be disclosed to CMS under the Stark Self-Referral Disclosure Protocol).

The upshot is that the updated SDP formally adopts many practices that have become fairly standard throughout the history of the program. Although the information may not be entirely new, the updated SDP more clearly outlines the OIG’s expectations for self-disclosing potential fraud and provides for a streamlined resolution of potential liability.


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