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Revisions to OIG Provider Self-Disclosure Protocol

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Johanna M. Novak
Foster Swift Health Care Law Report
May 2008

The Department of Health and Human Services Office of Inspector General ("OIG") recently refined its Provider Self Disclosure Protocol for voluntary disclosure of noncompliance with federal health care program requirements. The Protocol is intended to facilitate matters that potentially violate federal criminal or civil laws for which exclusions or civil monetary penalties ("CMP") are authorized. Disclosures that are characterized as mere billing errors or overpayments need not be disclosed pursuant to the Protocol but should instead be submitted directly by the provider to the appropriate claims-processing entity, such as the local Medicare contractor.

If a provider discovers some activity that could violate federal criminal or civil laws for which exclusions or CMP are authorized, that provider should first contact legal counsel. If, after further review, the activity is one that should be self-disclosed pursuant to the Protocol, then in addition to the basic information historically required in any disclosure, the revised guidelines require that providers also disclose the following:

  1. a complete description of the conduct being disclosed;
  2. a description of the provider’s internal investigation or a commitment regarding when it will be completed;
  3. an estimate of the damages to the federal health care programs and the methodology used to calculate that figure or a commitment regarding when the provider will complete such an estimate; and
  4. a statement of the laws potentially violated by the conduct.

For more information on the revised guidelines, see the OIG’s April 15, 2008, open letter to health care providers. And for more information on the basic information that should be included in any submission to the OIG, see Volume 63 of the Federal Register, Number 210, dated October 30, 1998.