Corporate Compliance

Tip: Avoid legal trouble by voluntarily self-disclosing conduct that may present False Claims Act liability.

Healthcare Auditing Weekly, September 23, 2008

Overpayments or other conduct that could result in FCA allegations generally should be investigated and disclosed within a reasonable time frame – the OIG recommends delivering reports within 60 days.
 
Report overpayment discoveries in one of three ways: 
  1. Within ordinary business. If the overpayment is confined to a small number of claims that can be identified separately, the organization may be able to return the overpayment simply by rebilling the claim.
  2. Formal self-disclosure. If the overpayments come from a practice error that results in a large number of inappropriate claims, consider using a more formal self-disclosure. Formal self-disclosures work in the mistake meets the following criteria:
    1. It occurred as a result of honest error
    2. It occurred with no intentional or reckless conduct
    3. The amount of the overpayment is low
    4. The error was not significant
  3. OIG’s Provider Self-Disclosure Protocol. If compliance efforts detect significant errors of reckless or intentional conduct, or if the amount of the errors at issue are excessive, consider the Provider Self-Disclosure Protocol published by the OIG.
This tip is adapted from The Healthcare Compliance Professional’s Guide to the False Claims Act. For more information about the book or to order your copy, visit HCMarketplace.

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