HHS, DOJ announce anti-fraud healthcare self-disclosure pilot program 

The Department of Health and Human Services and the Department of Justice Oct. 22 announced a six-month anti-fraud healthcare self-disclosure pilot program for companies that voluntarily disclose potential civil violations of the False Claims Act. The agencies said companies meeting the program’s requirements can resolve disclosed conduct through a coordinated civil release from liability under the False Claims Act and certain HHS administrative authorities. Participating companies are required to disclose all relevant information regarding potential violations; provide documentation showing the full nature and operation of the conduct; describe corrective actions taken; and provide a government repayment that would be 1.25 to 1.6 times the base self-disclosure repayment. The agencies said the multiplier will vary based on factors such as the timeliness of the disclosure, duration and scope of the misconduct, senior leadership involvement, any financial benefit to the company, and whether the company has successor liability for the misconduct but promptly remediated. Companies would then receive a release from the potential violations from DOJ.  

Additionally, the HHS Office of Inspector General would not impose an exclusion or require a corporate integrity agreement as part of the resolution. Also, CMS would not revoke the provider’s or supplier’s enrollment and billing privileges, and neither CMS nor HHS OIG would impose civil monetary penalties.