Changes require providers to supply information about potential violations of law.

In an open letter to healthcare providers, Health and Human Services Inspector General Daniel R. Levinson said the OIG has refined and improved the Provider Self-Disclosure Protocol, which healthcare providers use to voluntarily report fraudulent conduct affecting Medicare, Medicaid and other federal healthcare programs.

Healthcare providers use the SDP as a guide to voluntarily disclose federal healthcare program compliance issues that they believe potentially violate federal criminal, civil or administrative laws for which exclusion or civil monetary penalties are authorized, the OIG said in an April 15 press release. The SDP does not address disclosures that are characterized as mere billing errors or overpayments.

Since its inception in 1998, the SDP has helped the OIG return about $120 million to the Medicare Trust Fund, Levinson said in his April 15 letter. “Participating providers have avoided the costs and disruptions often associated with a government-directed investigation,” he said.

To improve the SDP process, Levinson said, the initial submission must contain the following information:

            • 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 healthcare programs and the methodology used to calculate that figure or a commitment regarding when the provider will complete such estimate

            • a statement of the laws potentially violated by the conduct.

            “This information must be included in addition to the basic information described in the SDP. The provider must be in a position to complete the investigation and damages assessment within three months after acceptance into the SDP,” the letter said.

Providers will benefit from the protocol if they submit a complete and informative disclosure, respond quickly to OIG’s requests for further information, and perform an accurate audit, actions that will indicate that providers have adopted effective compliance measures, Levinson said. The OIG expects full cooperation from disclosing providers, who will be removed from participation in the SDP unless they disclose in good faith and respond quickly to requests for more information.

The improved process will allow providers and the OIG to more efficiently and fairly resolve matters appropriately disclosed under the SDP, Levinson said.