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Published: 2008-03-26

OIG Sets Provider Self-Disclosure Protocol



What do you do if, during your compliance activities, you discover an overpayment that needs to be disclosed to the government? The Office of Inspector General (OIG) of the Department of Health and Human Services released its answer to this question in its October 21 Provider Self-Disclosure Protocol. However, healthcare providers should be aware of the pitfalls.

The voluntary protocol may be used by any provider, unlike OIG's Operation Restore Trust voluntary pilot program, and is intended to provide a viable opportunity for self-disclosure. The complete protocol can be found on the OIG's website at www.dhhs.gov/progorg/oig. It describes all the information the OIG expects to be included in a meaningful self-disclosure, including:

  • A description of the nature and extent of the improper practice.

  • The provider's discovery and response.

  • An estimate of the monetary impact of the disclosed matter.

The OIG will not provide any guarantees about the benefits of disclosure to the provider.

The OIG requests very detailed information to be included in these descriptions, including identification of corporate officials, employees or agents who either knew of, encouraged or participated in the practice or should have known of, but failed to detect the practice. The OIG also provides specific guidelines on how the monetary assessment should be conducted.

The Pitfalls

Although the OIG's guidance in this arena is useful, there are some major pitfalls. First, the provider must determine to which government entity it is appropriate to disclose the matter. Some overpayments may still be more appropriately handled by the carrier or intermediary. The OIG also indicates that, when it believes it is necessary, it will refer matters disclosed to it to the Department of Justice. Therefore, providers are cautioned it may be necessary to disclose simultaneously to several agencies. Since it is important to choose the forum and timing of disclosures carefully, providers are urged to seek legal counsel before making a disclosure.

The OIG's protocol is one indicator of how seriously the government takes providers' responsibility for self-monitoring compliance issues. When you find you have an issue requiring disclosure, recognize the OIG's protocol is a useful tool, but not a cure-all for disclosure questions. Some overpayments may still be more appropriately handled by the Medicare carrier or intermediary. The OIG also indicates that, when it believes it is necessary, disclosed matters will be referred to it to the Department of Justice. Therefore, providers are cautioned it may be necessary to disclose simultaneously to several agencies. Since it is important to choose the forum and timing of disclosures carefully, providers are urged to seek legal counsel before making a disclosure.

The OIG's protocol is one indicator of how seriously the government takes providers' responsibility for self-monitoring compliance issues. When you find you have an issue requiring disclosure, recognize the OIG's protocol is a useful tool, but not a cure-all for disclosure questions.