OIG Releases Open Letter to Health Care Providers

On April 15, 2008, the Department of Health and Human Services' Office of Inspector General (OIG) issued a Press Release announcing the release of an Open Letter to Health Care Providers. 

The Open Letter to Health Care Providers discusses refinements and clarifications that the OIG believes will increase the efficiency of the OIG's Provider Self-Disclosure Protocol and benefit providers who self-disclose.  Among other things, the Open Letter to Health Care Providers indicates that the OIG has concluded that an initial submission must include the following:

• a complete description of the conduct being disclosed;
• a description of the provider's internal investigation or a commitment regarding when it will be completed;
• an estimate of the damages to the Federal health care programs and the methodology used to calculate that figure or a commitment regarding when the provider will complete such estimate; and
• a statement of the laws potentially violated by the conduct.

In addition, the Open Letter to Health Care Providers indicates that providers must be in a position to complete the investigation and damages assessment within 3 months after acceptance into the Provider Self-Disclosure Protocol.  The Open Letter to Health Care Providers also reminds providers that the Provider Self-Disclosure Protocol is intended to facilitate the resolution of matters that potentially violate Federal criminal law, civil law, or administrative laws for which exclusion or civil monetary penalties are authorized and not mere billing errors or overpayments.  Further, the Open Letter to Health Care Providers states:

"A provider's submission of a complete and informative disclosure, quick response to OIG's requests for further information, and performance of an accurate audit are indications that the provider has adopted effective compliance measures.  Accordingly, when we negotiate the resolution of OIG's applicable administrative monetary and permissive exclusion authorities in exchange for an appropriate monetary payment, we generally will not require the provider to enter into a Corporate Integrity Agreement or Certification of Compliance Agreement.  We believe that this presumption in favor of not requiring a compliance agreement appropriately recognizes the provider's commitment to integrity and also advances our goal of expediting the resolution of self-disclosures."   

In 1998, the OIG introduced the Provider Self-Disclosure Protocol to encourage health care providers to voluntarily disclose self-discovered evidence of potential fraud against the Federal health care programs.  The OIG reports that the Provider Self-Disclosure Protocol has resulted in approximately $120 million being returned to the Medicare Trust Fund.