For at least the past twenty years, it has been better for health care providers to self-audit the books of their own practices and find their billing and claims errors before anyone else does.
Looking for your own possible Stark, Anti-kickback, or other potentially fraudulent activity is very important. It is also better to find your own patterns of overpayment, such as overcoding (billing for care unsupported by the chart), duplicate payments, unreconciled patient copays, and other mistakes that may not rise to the level of fraud, but are still considered abusive billing practices and expose health care providers to audits with extrapolation and enormous repayment findings.
U.S. Department of Health and Human Services Office of Inspector General (“OIG”) has now released a revised Provider Self-Disclosure Protocol, renamed the Health Care Fraud Self-Disclosure Protocol (SDP). It details procedures to sidestep much of the adversarial posture of healthcare fraud litigation, and it also confirms the procedures for handling self-identified findings of abuse, through voluntary repayment.
For the first time since 2013, the OIG has updated its 1999 rules with new procedures for how health care providers can benefit from discovering their own overpayments and voluntarily disclosing them before they have been audited. There are different procedures for practices to self-report different types of errors, fraud and/or abuse.
With the help of an experienced health care law attorney, providers can benefit greatly from self-reporting and entering into voluntary repayment plans. For example, they may avoid the costly litigation that comes with fraud claims. They may enjoy reduced multiplier calculations, and they may be released from the OIG’s permissive exclusion authorities without integrity agreement obligations.
"Benefits of the Self-Disclosure Procedures include potentially minimizing costs and disruptions for the disclosing party"