OIG’s Release of Updated Provider Self-Disclosure Protocol

On April 17, 2013, the Office of Inspector General (OIG) released an updated Provider Self-Disclosure Protocol (SDP). The SDP offers providers a process for voluntarily identifying, disclosing, and resolving conduct in violation of the federal fraud and abuse laws, as well as guidance on investigating, reporting, and quantifying the damages of the conduct. This is the first revision that the protocol has seen since its initial release in October of 1998, and while the basic elements have been retained, there are several changes that are worth noting. Some of most significant revisions included:

Notable New Features:

  • Self-disclosures involving kickback-related submissions have a minimum settlement amount of $50,000, and all other disclosures have a $10,000 minimum settlement amount.
  • Overpayment reporting obligations under the 60-day rule are to be suspended pending settlement, withdrawal, or removal from the SDP.
  • Internal investigations to be completed and damages to be calculated within 90 days of initial self-disclosure, as opposed to 90 days of OIG’s acceptance of submission.
  • Billing-related disclosures now have a 100 unit minimum sample with the use of a mean point estimate in damage calculations.
  • Acknowledgement of damage calculation methodologies that vary depending on the type of disclosure being resolved.

While the OIG recognizes the significance of the decision to disclose potential fraud, they also remind providers of the benefits to doing so. Good faith disclosures not only indicate an effective compliance program, but they generally result in lower settlement amounts and the absence of a Corporate Integrity Agreement (CIA) should the provider fully cooperate. Also emphasized is the importance of the timing involved with a disclosure and the need for specificity. Due to the timeframe changes, providers need to be committed to finishing their internal investigations within 90 days of their submission. Disclosures that are incomplete or lacking important details will be rejected, resulting in unnecessary delays.

To access the updated SDP go the following link: https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf

HC Healthcare Consulting has extensive expertise in coding and billing compliance. Our staff includes certified coders, consultants certified in healthcare compliance, and certified public accountants that are available to provide expert assistance with compliance programs.

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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