OIG’s Updated Self-Disclosure Protocol Reinforces the Need for Compliance Programs in Physician Practices

On April 17, 2013, the OIG published the Updated Provider Self – Disclosure Protocol. This update emphasizes the “legal and ethical duty to take measures to detect and prevent fraudulent and abusive activities, including implementing specific procedures and mechanisms to investigate and resolve instances of potential fraud involving the Federal health care programs.” This is clear language that should reinforce the need for an efficient and robust compliance program.

The updated SDP clarifies guidance for calculating damages in the three important categories of False Billing, Excluded Individuals, and the Anti-Kickback Statute and Stark. Notable changes for physician practices emphasize the importance of being proactive and implementing an effective compliance program.

The updated SDP:

  • Acknowledges that individuals seeking resolution through the SDP process deserve the benefit of a lower multiplier of damages.
  • States that SDP participation may mitigate potential exposure under the mandatory 60-day disclosure rule that governs overpayments.
  • Confirms a presumption against a corporate integrity agreement (CIA) for settlements reached under the SDP

OIG’s Updated SDP can be found here-

https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf