Hospitals and health systems that uncover potential criminal fraud within their organizations now have one place to report it and still receive credit from two federal agencies.
The Justice Department’s National Fraud Enforcement Division and HHS’ Office of Inspector General issued a policy Oct. 15 that lets healthcare companies self-disclose potential criminal conduct to the Fraud Division alone. That one disclosure earns the benefits of both the Justice Department’s Corporate Enforcement Policy and HHS-OIG’s Health Care Fraud Self-Disclosure Protocol, with no separate submission required through the HHS-OIG portal, according to an Oct. 15 news release from the Justice Department.
The change settles a question hospital executives and compliance leaders have had to weigh when problems surface: not only whether to come forward, but where. The agencies said a single arrangement, such as an illegal kickback, billing Medicare for medically unnecessary services or concealing an excluded provider, can carry criminal, civil and administrative consequences at once.
HHS-OIG also updated its protocol to draw a clearer line. The protocol covers conduct that may violate civil or administrative law; criminal conduct should go to the Justice Department. A health system that discloses only to HHS-OIG generally will not have made a voluntary self-disclosure to the Justice Department and generally will not qualify for a declination on that basis. The agencies advise organizations seeking the benefits of both programs to bring potentially criminal conduct to the Fraud Division first.
For hospital and health system leaders, the policy simplifies the first step after an internal investigation turns up potential criminal conduct tied to Medicare or another federal program: The disclosure goes to the Justice Department’s Fraud Division, the release said.
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