Provider self-disclosure protocols also published

The Office of the Inspector General (OIG) also published new guidelines for its program establishing protocols for voluntary disclosure of Medicare and Medicaid fraud to the government. Published in the Oct. 30, 1998, Federal Register,1,2 the Provider Self- Disclosure Protocol replaces a pilot program that was established as part of the OIG’s 1995 Operation Restore Trust project.

The protocol is meant to encourage health care providers to make voluntary disclosures about fraudulent, abusive, and wasteful activities. It gives detailed guidance to the provider on what information is appropriate to include as part of an investigative report and how to conduct an audit on the matter.

Self-disclosure will not protect the provider from civil and criminal prosecution under the False Claims Act, but it may facilitate a resolution. A lack of cooperation with the OIG may be considered an aggravating factor in the resolution of the investigation.

Intentionally submitting false or misleading information or omitting relevant information may result in criminal and/or civil sanctions, as well as exclusion from participation in the federal health care programs.

To view the text of the Provider Self-Disclosure Protocol, go to http://www.dhhs.gov/progorg/oig/modcomp/oigdis.pdf.

References

1. 63 Federal Register 58341 (Oct. 30, 1998).

2. 63 Federal Register 58399 (Oct. 30, 1998).