OIG Voluntary Disclosure

If you realize that your conduct or the conduct at your company or organization violated the Anti Kickback statute or other health care fraud and abuse laws, you may be eligible to take advantage of the OIG voluntary disclosure program. The OIG voluntary disclosure program was developed to permit health care providers to mitigate the potential civil monetary penalties, False Claims Act liability, and even exposure to criminal charges.

What is the OIG Voluntary Disclosure Program?

The Office of Inspector General has implemented three versions of the voluntary disclosure program since 2008. Voluntary disclosure may provide providers with an effective strategy to avoid the negative, sometimes devastating consequences, of a government investigation targeting false billing, improper compensation arrangements resulting in violation of the Anti-Kickback Statute, the hiring of an excluded employee, or any other violation that may be punished through a civil monetary penalty.

Am I Eligible for the OIG Voluntary Disclosure Program?

According to OIG’s most recent guidance, any provider not already subject to Government inquiry, audit, investigation, or “other oversight activities” might be eligible to enter the OIG’s Voluntary Disclosure Program.

But, according to OIG, disclosing parties already subject to a Government inquiry, audit, investigation, or “other oversight activities” are not automatically precluded from making a disclosure although a disclosure must be made in “good faith” and not for the purpose of circumventing an ongoing inquiry.

What are some of the benefits of entering the OIG’s Voluntary Disclosure Program?

Some of the benefits associated with disclosure might  include:

1. The Department of Justice Civil Division might grant a provider a release from any liability based on violations of the False Claims Act.
2. Once a disclosure is made to OIG, the statute of limitations might begin to run on any potential qui tam/whisteblower lawsuit action.
3. A provider might avoid exclusion which can be a business “death sentence” for smaller providers relying on participation in federal health care programs.
4. A provider might avoid the requirement to enter into an Integrity Agreement in order to avoid exclusion.
5. The voluntary disclosure program establishes a multiplier of 1.5 as a starting point, instead of a multiplier of 3, for the damages that providers might be required to pay under the program.
6. Disclosure suspends a provider’s overpayment reporting obligations and the disclosing party’s obligation to report an overpayment to Medicare or Medicaid.
7. Disclosure and cooperation during the disclosure process are factors considered by Department of Justice Criminal Division and the Federal Sentencing Guidelines which means they are also factors considered by federal prosecutors before they decide whether or not to bring charges against a particular provider.

What Are Some of the Risks Associated With Entering the OIG’s Voluntary Disclosure Program?

Although there are potential benefits of entering the OIG’s Voluntary Disclosure Program, disclosure may not always be the best option for each client. There is an automatic, minimum $50,000.00 penalty for any disclosure based on a violation of the Anti-Kickback Statute and there are no guarantees once a provider is accepted into the program and a provider can be removed from the OIG Voluntary Disclosure Program. Further, disclosure under the OIG Voluntary Disclosure Program requires complete disclosure, ongoing cooperation, and admitting to a violation that OIG may punish by imposing a civil monetary penalty.

What is the Deadline for a Provider to Enter the OIG’s Voluntary Disclosure Program?

OIG has established three different versions of the OIG Voluntary Disclosure Program, but there are no deadlines and there is no guarantee that OIG will continue the OIG Voluntary Disclosure Program or that OIG will continue the OIG Voluntary Disclosure Program in its current format.

This Power Point on OIG Voluntary Disclosure also provides some helpful guidance.