Provider Self Disclosure Process

May 22, 2014

A growing area of the health care legal practice involves counseling clients on issues that could require self disclosure under OIG or CMS procedures.

The Office of Inspector General has procedures that a provider may follow to disclose possible violations of the Anti-Kickback Statute or other federal laws. Providers have the opportunity to avoid much more serious consequences that could arise from federal prosecution or civil action. The Center for Medicare and Medicaid Services has a similar procedure that can be used to disclose and settle violations of the federal Stark Law

There are a number of factors that providers must consider when deciding whether to use either self disclosure process. The first factor is always to determine whether a violation of any applicable law has occurred. The answer to the threshold question is oftentimes not as clear as one would hope in situations that can result in such serious consequences.

Even if the compliance problem is clear, it is often difficult to determine the extent of the problem or the amount of overpayment that might be at issue. If you encounter a situation that you believe may involve a compliance infraction, it is best to obtain professional advice on the process to follow that will reduce your risk of exposure. Not every error in billing requires you to use the self disclosure process. Knowing when the formal process should be used can be difficult and generally requires a documented investigation of all facts and circumstances.

I have posted a number of blog articles on our health law blog which you can read to get further background on the self disclosure process. Links to some of my past articles on this topic follows:

New 2013 Self Disclosure Protocols

OIG Self Disclosure Protocol Revisions Explained

Voluntary Self Disclosure Decisions Can Be Complicated

Stark Law Self Disclosures Through 2013

Stark Law Period of Disallowance

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