Health Care Fraud Self-Disclosure Protocol: Navigating Amended Guidance for Providers and Suppliers

Recording of a 90-minute CLE video webinar with Q&A

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Conducted on Thursday, March 10, 2022

Recorded event now available

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Course Materials

This CLE course will guide health care counsel on the recent changes to the Department of Health and Human Services (HHS) Office of the Inspector General's (OIG) Self-Disclosure Protocol. The panel will also briefly discuss the CMS Self-Referral Disclosure Protocol, which has not changed since 2017. The panel will offer best practices for evaluating the advantages and disadvantages of disclosing potential violations and navigating the new guidance.

Description

In November 2021, the OIG amended the Provider Self-Disclosure Protocol, including renaming the Protocol the "Health Care Fraud Self-Disclosure Protocol." Among the changes are: increases in the minimum amounts required for settlements under the Protocol and changes in the scope of which federal health care program damages must be calculated.

In contrast to the prior version of the Protocol, the new Protocol indicates that if the Department of Justice (DOJ) participates in any settlement, the DOJ will determine how the matter will be resolved as DOJ determines is appropriate, consistent with DOJ's resolution of FCA cases. This could include DOJ's calculation of FCA damages for Anti-Kickback Statute violations based on paid claims, which is typically a higher amount than OIG requires under its Protocol.

Counsel to health care providers must understand the potential avenues for reporting and resolving self-disclosures and the advantages and disadvantages of the options.

Listen as our authoritative panel of health care attorneys examines the recent changes to the OIG's Self-Disclosure Protocol.

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Outline

  1. Evaluating whether to disclose and options for disclosures
    1. This topic will also cover understanding when to use OIG's Self-Disclosure Protocol versus CMS' Self-Referral Disclosure Protocol
  2. OIG's Self-Disclosure Protocol and the amended guidance
  3. Best practices for self-disclosures and navigating the new guidance

Benefits

The panel will review these and other key issues:

  • What changes were made to the OIG's Self-Disclosure Protocol?
  • Which avenue should healthcare providers use when making a self-disclosure?
  • What are best practices for healthcare providers and their counsel when preparing OIG Self-Disclosure Protocol or CMS Self-Referral Disclosure Protocol disclosure submission?

Faculty

Fitzgerald, T. Jeffrey
T. Jeffrey Fitzgerald

Shareholder
Polsinelli

Mr. Fitzgerald’s practice focuses on defending healthcare clients in healthcare fraud investigations. He believes...  |  Read More

Sorensen, Heidi
Heidi A. Sorensen

Counsel
Alston & Bird

Ms. Sorensen builds on her previous experience at the Office of Counsel to the Inspector General of the Department of...  |  Read More

Yount, Rachel
Rachel E. Yount

Attorney
Mintz Levin Cohn Ferris Glovsky and Popeo

Ms. Yount's practice involves a variety of regulatory, compliance, and transactional matters for a broad range...  |  Read More

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