OIG Provider Self-Disclosure Protocol Updated
May 2, 2013 04:08 PM
The U.S. Department of Health and Human Services Office of Inspector General ("OIG") issued a Provider Self-Disclosure Protocol ("SDP") update on April 17, 2013. This revised SDP supersedes and replaces the 1998 notice. According to OIG, the health care industry has an obligation to take measures to detect and prevent fraud and abuse. This obligation includes implementation of procedures and mechanisms to investigate and resolve instances of potential fraud.
The SDP protocol announcement opens with a discussion of the benefits of disclosures, including the fact that OIG believes self-disclosures are indicators of an effective compliance program. As a result, persons engaging in self-disclosure deserve to pay lower damages. OIG expressed its commitment to work with members of the health care industry that use SDP to resolve improper payments. They’ve reduced the timeframe for completion of its investigation to damage calculation to 90 days from the date of the initial submission and to reduce settlement multipliers, usually a minimum multiplier of 1.5 times single damages.
The notice identifies who may use the SDP to include all health care providers, suppliers, or other individuals or entities subject to OIG’s Civil Monetary Penalty authority. Conduct eligible for the SDP includes matters that potentially violate federal criminal, civil, or administrative CMP laws. Prior to disclosure, the entity must ensure that the conduct has ended and corrective action will be taken. In addition to establishment of a minimum multiplier of 1.5 times single damages and shortened timeframe for arrival at a damage calculation, other changes included:
Acknowledgement that parties using the SDP will likely not have to enter into a corporate integrity agreement with the OIG
A requirement that disclosing parties acknowledge that the reported conduct is a potential violation of federal law
Clarification that disclosing parties must waive certain defenses
Clarification that the OIG will coordinate with the Department of Justice ("DOJ") and the Centers for Medicare and Medicaid
Requirements of Disclosures
SDP submission content is detailed along with disclosure and certifications. Investigation and estimated damages must be reported along with details about sampling methodologies employed. Additionally, conduct involving excluded persons and corrective action taken must be disclosed.
In its concluding remarks the OIG states: “resolution of a matter in the SDP depends on cooperation, realistic expectations, and clear communication between OIG and the disclosing party.”