Healthcare Fraud Self-Disclosure: Understanding Reporting Methods; Conducting Investigations; Quantifying Damages

This CLE course will guide healthcare counsel through the Department of Health and Human Services (HHS) Office of the Inspector General's (OIG) Self-Disclosure Protocol. The panel will also briefly discuss the CMS Self-Referral Disclosure Protocol. The panel will offer best practices for evaluating the advantages and disadvantages of disclosing potential violations and navigating OIG's guidance.

The HHS OIG's "Health Care Fraud Self-Disclosure Protocol" allows healthcare providers to voluntarily identify, disclose, and resolve instances of potential fraud involving federal healthcare programs. The Protocol provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider's liability under the OIG's CMP authorities.

In the most recent amendments to the Protocol in 2021, the OIG increased the minimum settlement amounts and changed the scope of which federal healthcare program damages must be calculated.

The Protocol indicates that if the Department of Justice (DOJ) participates in any settlement, the DOJ will determine how the matter will be resolved as DOJ determines is appropriate, consistent with DOJ's resolution of FCA cases. This could include DOJ's calculation of FCA damages for Anti-Kickback Statute violations based on paid claims, which is typically a higher amount than OIG requires under its Protocol.

Counsel to healthcare providers must understand the potential avenues for reporting and resolving self-disclosures and the advantages and disadvantages of the options.

Listen as our authoritative panel of healthcare attorneys examines the OIG's Self-Disclosure Protocol.