Healthcare Fraud Self-Disclosure: Understanding Reporting Methods; Conducting Investigations; Quantifying Damages
Navigating OIG's Guidance for Providers and Suppliers
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Tuesday, November 7, 2023
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will guide healthcare counsel through the Department of Health and Human Services (HHS) Office of the Inspector General's (OIG) Self-Disclosure Protocol. The panel will also briefly discuss the CMS Self-Referral Disclosure Protocol. The panel will offer best practices for evaluating the advantages and disadvantages of disclosing potential violations and navigating OIG's guidance.
Ms. Sorensen builds on her previous experience at the Office of Counsel to the Inspector General of the Department of HHS to assist clients with health care regulatory, compliance, and fraud and abuse matters. She focuses her practice on health care fraud and abuse and compliance matters, including the Anti-Kickback Statute. Ms. Sorensen assists clients in False Claims Act investigations, negotiating FCA settlements and corporate integrity agreements, and matters that fall under the Civil Monetary Penalties Law and OIG exclusion authorities. She helps clients develop compliance programs and implement corporate integrity agreements. Ms. Sorensen previously served as chief of the Administrative and Civil Remedies Branch in the Office of Counsel to the Inspector General (OCIG) at HHS. She served as the OCIG’s coordinator for both the Provider Self-Disclosure Protocol and the Physicians at Teaching Hospitals national project and also served the OCIG as senior counsel and deputy branch chief.
Mr. Fitzgerald’s practice focuses on defending healthcare clients in healthcare fraud investigations. He believes effective strategies for successfully defending investigations include the rigorous exploration of the facts and a detailed analysis of the applicable regulations. Mr. Fitzgerald represents healthcare providers in disputes with federal and state licensure bodies, professional licensure boards, and other regulators and law enforcement agencies. He also assists healthcare companies that have proactively discovered potential compliance issues. Mr. Fitzgerald uses his experience in resolving investigations to develop practical solutions that bring finality and risk reduction to compliance problems.
The HHS OIG's "Health Care Fraud Self-Disclosure Protocol" allows healthcare providers to voluntarily identify, disclose, and resolve instances of potential fraud involving federal healthcare programs. The Protocol provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider's liability under the OIG's CMP authorities.
In the most recent amendments to the Protocol in 2021, the OIG increased the minimum settlement amounts and changed the scope of which federal healthcare program damages must be calculated.
The Protocol indicates that if the Department of Justice (DOJ) participates in any settlement, the DOJ will determine how the matter will be resolved as DOJ determines is appropriate, consistent with DOJ's resolution of FCA cases. This could include DOJ's calculation of FCA damages for Anti-Kickback Statute violations based on paid claims, which is typically a higher amount than OIG requires under its Protocol.
Counsel to healthcare providers must understand the potential avenues for reporting and resolving self-disclosures and the advantages and disadvantages of the options.
Listen as our authoritative panel of healthcare attorneys examines the OIG's Self-Disclosure Protocol.
- Evaluating whether to disclose and options for disclosures
- This topic will also cover understanding when to use OIG's Self-Disclosure Protocol versus CMS' Self-Referral Disclosure Protocol
- OIG's Self-Disclosure Protocol and most recent guidance
- Best practices for self-disclosures and compliance
The panel will review these and other key issues:
- Which avenue should healthcare providers use when making a self-disclosure?
- What are best practices for healthcare providers and their counsel when preparing OIG Self-Disclosure Protocol or CMS Self-Referral Disclosure Protocol disclosure submission?
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