The Department of Health and Human Services Office of Inspector General (OIG) recently published a list of provider self-disclosure settlements under the OIG Self-Disclosure Protocol (SDP) in the first half of calendar year 2018, resolving alleged violations of the Civil Monetary Penalties Law. The SDP permits health care providers to disclose conduct that may be violative of federal criminal, civil and administrative laws for which civil monetary penalties are authorized. Providers may submit disclosures through the OIG’s website or by mail. The SDP is not available for disclosure of an arrangement that involves only liability under the Stark Law without accompanying potential liability under the Anti-Kickback Statute for the same arrangement. Stark-only conduct may be disclosed to the Centers for Medicare and Medicaid Services through its Self-Referral Disclosure Protocol.

Benefits of self-disclosure under the SDP include: (i) a presumption against requiring integrity obligations in exchange for a release of OIG’s permissive exclusion authorities in resolving an SDP matter; (ii) payment of a lower multiplier on single damages than would normally be required in resolving a government-initiated investigation; (iii) suspension of an obligation to report and repay overpayments under the Medicare 60-day repayment rule; and (iv) reduction of the average time a case is pending with the OIG to less than 12 months from acceptance into the SDP.

Common violations disclosed under the SDP in the first half of calendar year 2018 included:

  • Submission of claims for services lacking proper documentation, including medical necessity and justification for the assigned code level
  • Employment of an individual that the provider knew or should have known was excluded from participation in federal health care programs
  • Payment by health care institutions of remuneration to referring physicians in the form of space and equipment leases that were below fair market value
  • Submission of claims for reimbursement for services provided by individuals who lacked required certifications or licensure

The List of Recently Settled Provider Self-Disclosures can be viewed on the OIG’s website.