Medicare Compliance & Reimbursement

Tip: Self-identification reduces potential fallout.

Should you find you or your organization are out of compliance with any rules and regulations, avoid disaster with this advice from the HHS Office of Inspector General (OIG). In the recently published “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” the OIG stresses the importance of self-identification and self-reporting of compliance problems.

As an enticement, the OIG lists in the guide the benefits of self-disclosing compliance problems under the OIG’s Self-Disclosure Protocol:

1. Faster resolution — The average OIG self-disclosure case is resolved in less than one year.

2. Lower payment — The OIG settles most self-disclosure cases for 1.5 times damages, rather than for double or treble damages and penalties available under the False Claims Act.

3. Exclusion release — You can obtain an exclusion release as part of a settlement with no Corporate Integrity Agreement (CIA) or other compliance obligations.

Bottom line: The OIG stresses that “providers have legal and ethical obligations to disclose known violations of law occurring within their organizations.” Boards should discuss with management how to handle identification of probable violations, including self-disclosure of such issues to the government, the OIG says.