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HHS OIG Updates Healthcare Fraud Self-Disclosure Protocol

Analysis  |  By John Commins  
   November 08, 2021

The revision unveiled this week incorporates legal changes made since the last revision to the SDP in 2013.

The Department of Health and Human Services Office of Inspector General this week released an update to the Health Care Fraud Self-Disclosure Protocol.

Established in 1998, the SDP can be used by providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties to voluntarily disclose self-discovered evidence of potential fraud.

Self-disclosure gives providers the opportunity to avoid the costs and disruptions associated with a government-directed investigation and civil or administrative litigation. The revision unveiled this week incorporates legal changes made since the last revision to the SDP in 2013.

What's changed?

  • Increased the minimum amounts required to settle under the SDP to match new statutory minimum penalty amounts.
     
  • Required SDP submissions to be made through the HHS-OIG website.
     
  • Added references to OIG's 2019 Grant and Contract SDPs.
     
  • Clarified that CIA Reportable Events can be disclosed under the SDP.
     
  • Clarified that DOJ sometimes settles SDP cases.
     
  • Clarified that disclosures must include damages to each affected federal healthcare program and the sum of all damages.
     
  • Made technical changes to statistics, terminology and background facts.

What hasn't changed?

  • Timelines and content requirements.
     
  • Methods for calculation of damages.
     
  • Timely settlement with a lower multiplier and an exclusion release.
     

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


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