Thursday, May 2, 2013

OIG Revised Provider Self-Disclosure Protocol

In April, the US Department of Health and Human Services, Office of Inspector General (OIG) revised its Provider Self-Disclosure Protocol (SDP) again - it was originally published in 1998, and updated in 2006, 2008, 2009 and now 2013. This most recent revision replaces the original publication and updates. By way of background, all individual or entities subject to OIG’s civil monetary penalty (CMP) authority are eligible to use the SDP to resolve any liability arising from a potential violation of federal criminal, civil or administrative laws where CMPs are authorized. Conduct where CMPs are not authorized, e.g., simple overpayments or errors, are not eligible for resolution through the SDP.

In the updated SDP, OIG continues to emphasize the importance and benefits of voluntary disclosure; and attempts to streamline the internal process for disclosures to reduce the average time a case is pending with OIG. To keep within the new timeframe, OIG requires that internal investigations and damage calculations be submitted 90 days from the date of an initial submission versus 90 days from acceptance into the SDP. This tightened timeframe may prove challenging. For disclosures involving false billing, OIG requires the disclosing provider to conduct a review to estimate the improper amount paid by the federal healthcare programs. These damage estimates can be derived from the actual claims submitted or from a sample.

For disclosures involving excluded persons (which is the most common scenario for LTC providers), OIG clarified that the disclosing party must describe:
  1. identity, job and dates of employment of excluded individual;
  2. screening and background check procedures; 
  3. how the conduct was discovered; and
  4. any corrective action taken.
Before making this type of disclosure, the provider must screen all current employees and contractors against OIG’s List of Excluded Individuals and Entities (LEIE), and estimate damages related to the excluded individual. To obtain a copy of the SDP go to

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