Issue link: https://beckershealthcare.uberflip.com/i/164052
Legal & Regulatory Issues 46 Updated Fraud Self-Disclosure Protocol: 5 Considerations for Healthcare Providers By Molly Gamble I n April, the Office of Inspector General of the HHS issued an updated provider self-disclosure protocol, revised from the SDP published in 1998. The updated protocol instructs healthcare providers on what to do if they discover actions violate federal fraud and abuse laws, including false billings, activity involving potential violations of the AntiKickback Statute or potential violations of the Stark Law. Updating the 1998 SDP was a multi-year process, as the OIG issued open letters to healthcare providers in 2006, 2008 and 2009 for suggestions on how to improve the SDP. It also solicited comments on the SDP in June 2012, receiving "numerous helpful comments" from the public. "Since the original publication [of the SDP], we identified areas where additional guidance would be beneficial to the healthcare community and would improve the efficient resolution of SDP matters," the OIG wrote when announcing the updated protocol. The OIG said some of the most common issues providers disclose include: • Billing for items or services furnished by excluded individuals. • Evaluation and management services and DRG upcoding. • Duplicate billing. • Alteration or falsification of records. • Kickbacks and Stark Law violations. The updated SDP reiterates that the OIG will require a minimum settlement of $50,000 for anti-kickback statute-related disclosures made pursuant to the SDP, and it also states that the OIG requires a minimum settlement of $10,000 for all other matters. The OIG describes self-disclosure as a "significant decision" for healthcare providers, but one that can also yield significant benefits. Holly Carnell, JD, and David Pivnick, JD, both attorneys with McGuireWoods LLP in Chicago, explain some of the key considerations for healthcare providers in deciding whether to self-disclose false billings, activity involving potential violations of the Anti-Kickback Statute or potential violations of the Stark Law. What are some of the main benefits of self-disclosure? 1. The risk of a whistleblower action is going to decrease if providers self-disclose. "The government has increased its healthcare fraud enforcement budget in recent years by huge proportions and is intervening in more whistleblower cases, and the number of qui tam KEEPING PEOPLE HEALTHY IS YOUR BUSINESS KEEPING YOUR BOTTOM LINE HEALTHY IS OURS Today, it's critical to the success of your company to adjust to the changing healthcare landscape. That's why selecting a strong financial partner is more important than ever. As one of the top 50 financial institutions in the U.S., Associated Bank's Healthcare Group has the people and solutions to understand your unique challenges — and the size and strength to make things happen. Karen Anillo Senior Vice President and Team Leader, Healthcare Group 312-552-2464 | Karen.Anillo@AssociatedBank.com T RE ASURY M ANAG E M E NT | C A P I TA L MA R KETS | SY N D I C ATI O N S Loans subject to credit approval. Equal Opportunity Lender. Associated Bank, N.A. is a Member FDIC and Associated Banc-Corp. (7/13) 4130 @AssociatedBiz AssociatedBank.com