Kusserow’s Corner: OIG Online Self-Disclosure Protocol

On April 17, 2013, the HHS Office of Inspector General (OIG) issued new guidance on the self-disclosure protocol (SDP) that superseded the original SDP, with additional guidance and clarification of the process, as well as new requirements for those making self-disclosure.  On July 8, 2013, it posted on its website a “Self-Disclosure Online Form” to further expedite the disclosure process.  Providers who wish to voluntarily disclose self-discovered evidence of potential fraud to the OIG may do so under the SDP. Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.

The OIG points out that it endeavors to work cooperatively with providers who are forthcoming, thorough, and transparent in their disclosures in resolving these matters. While the OIG does not speak for the Department of Justice or other agencies, it consults with those agencies, as appropriate, regarding the resolution of SDP matters. Providers interested in submitting an SDP may wish to consider the following:

  1. Ensure a thorough internal investigation is made prior to entering the SDP process.
  2. The OIG has little tolerance for incomplete or untimely disclosure.
  3. Providers need to meet timeframes for submitting required reports and damage estimates.
  4. Provides must acknowledge, in writing, potential violations of specific federal law(s) and fully describe the relevant conduct.
  5. Disclosures limited solely to potential Stark Law liability must be referred to CMS, not the OIG.
  6. Potential Anti-Kickback Statute (AKS) liability, either alone or coupled with Stark Law liability, should be disclosed to the OIG through its SDP.
  7. The OIG will use a 1.5 multiplier and provide a presumption against having a corporate integrity agreement (CIA).

Richard P. Kusserow served as DHHS Inspector General for 11 years.  He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters.  His firm has a number of experienced health care consultants that act as both Designated and Interim Compliance Officers.  The SM sister company, Compliance Resource Center (CRC), provides a wide range of compliance tools, including sanction-screening. 

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.