I Found Out I Employed An Excluded Party…Now What?
(Understanding Self-Disclosure Protocol)
Discovering that you’ve employed an excluded individual can happen even to the most meticulous in the health care industry. How you address it is another thing altogether.
Properly addressing the issue means understanding what Self-Disclosure entails. The Self-Disclosure Protocol (SDP) can actually benefit a company that has an excluded individual or provider, so here is a synopsis of important points to guide you through the process.
For a full updated report on the OIG’s Provider Self-Disclosure Protocol, click here.
Know why Self-Disclosure is important and what benefits it offers.
The OIG published the Provider Self-Disclosure Protocol in 1998 as a process for health care providers to identify, disclose, and resolve instances of potential fraud involving the Federal health care programs. In the past 15 years, the OIG has resolved over 800 disclosures. This has resulted in recoveries of over $280 million to Federal health care programs.
Self-disclosure is important simply because all members of the health care industry have a legal and ethical duty to do so. Its benefits include:
- the OIG recognizing your company as having an effective compliance program.
- hundreds of SDP cases having been resolved through settlements since 2008.
- a significantly lower multiplier on single damages, compared to having to go through a Government-initiated investigation.
- the OIG streamlining its internal process so that the average time of a pending case is reduced to less than 12 months from its acceptance into the SDP.
Learn the applicable SDP for your case.
An entire section of the OIG’s Provider’s SDP explains the eligibility criteria and guideline of Self-Disclosure (Chapter II). In a nutshell, the SDP is not limited to any particular industry, medical specialty, or type of service. Any individual or entity that makes a submission to the SDP is referred to as a “disclosing party”, and is responsible for disclosing conduct that potentially violates Federal criminal, civil, or administrative laws.
A page in the OIG website is dedicated to Self-Disclosure reports. It offers information and describes the processes of reporting potential medical fraud. You will need to choose the SDP process that is applicable to you: either the Provider Self-Disclosure or the Contractor Self-Disclosure.
The Provider SDP is for healthcare providers and suppliers subject to Civil Monetary Penalties. It gives you the chance to avoid civil and administration investigation-related costs by disclosing evidence of medical fraud. A printable document and a link to self-disclosure online submission is available on this page.
On the other hand, the Contractor SDP is for individuals or businesses who are awarded government contracts and subcontracts that provide Health and Human Services (HHS). This is for contractors who discover potential violations of the False Claims Act and issues of fraud, bribery, and gratuity. To submit a Contractor Self-Disclosure, you can follow the guidelines on this OIG page.
Self-disclosure reports should be submitted properly and not merely reported over the OIG hotline.
Follow the SDP time frame.
To further facilitate timely resolutions of SDP matters, the OIG changed the time frame for submission of findings of the completed internal investigation and damages calculation from 90
days from acceptance into the SDP to 90 days from the date of the initial submission.
Give the specific requirements for disclosure of excluded persons.
The Self-Disclosure report must be as specific and detailed as possible. The required details include:
- the excluded person(s)’s identity/identities
- the excluded person(s)’s Federal Tax ID number and any provider identity number
- the excluded person(s)’s duties
- the dates of the excluded person(s)’s employment/contract
- all background checks done on the excluded person(s) during the time of their employ/contract
- the provider’s screening process
- why the individual was hired
- how the situation came to light
- the corrective measures taken after the discovery (including a copy of any revised policy or procedure implemented to prevent future hiring of excluded individuals)
In addition, before disclosing the employment of an excluded individual, a disclosing party must screen all current employees and contractors against the LEIE. Once this has been done, the disclosing party should disclose all excluded persons in one submission.
Calculate the damages.
For organizations who use the SDP, the OIG practices a minimum of 1.5 times the amount paid by the federal health care program compared to about double the amount in a government-initiated investigation. This will keep penalties and exclusion fines going through the roof. However, this multiplier still depends on the exclusion situation, which is why a detailed report submitted in a timely manner is a must.
