Corporate Compliance

Tip: Avoid legal trouble with self-disclosure

Compliance Monitor, June 25, 2008

Hospitals can avoid legal trouble by self-disclosing conduct that may present False Claims Act liability, but deciding how to report compliance findings is often difficult. 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 by simply rebilling the claim. This is the preferred way of handling small, controlled problems.
2. Formal self-disclosure. If individual rebilling is not feasible, consider using a more formal self-disclosure. Formal self-disclosures work if the following criteria are met:
  • It occurred as a result of honest error
  • It occurred with no intention or reckless conduct
  • The amount of the overpayment is low
  • 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 is extensive, consider the Provider Self-Disclosure Protocol published by the OIG.
This tip was adapted from The Healthcare Compliance Professional’s Guide to the False Claims Act. For more information about the book or to order your copy, click here.


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