The Office of Inspector General has issued its Provider Self-Disclosure Protocol, which outlines the process for healthcare providers to follow when they discover conduct that may violate federal fraud and abuse laws.
When providers discover a problem, the OIG says there are three things they should do:
When self-reporting to the OIG, the agency recommends providers avoid disclosing any information prematurely. They also ask for specific and descriptive information on conduct and prompt responses to OIG requests for more information.
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When providers discover a problem, the OIG says there are three things they should do:
- Clarify the issue and confirm it is potential fraud abuse. If it is an innocent mistake or an overpayment, those issues can be reported through the normal refund process with the provider's Medicare contractor.
- Consult with a healthcare attorney who has experience with federal healthcare programs. The attorney will confirm if there is a problem and, if so, discuss the provider's options.
- Decide where to disclose the conduct. Providers can disclose to OIG, which has a protocol, or CMS, which has created a disclosure process specifically for Stark Law violations. Disclosure to the local U.S. Attorneys' Office may also be appropriate depending on the conduct.
When self-reporting to the OIG, the agency recommends providers avoid disclosing any information prematurely. They also ask for specific and descriptive information on conduct and prompt responses to OIG requests for more information.
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