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Provider Self Disclosure Decisions – Voluntary Disclosure Process
The decision whether or not to voluntarily disclose to the government can be very difficult. Not every case is clear.
Clearly not every situation where there has been a billing error amounts to fraud or wrongdoing requiring use of the self-disclosure protocol. Many over-payments that are identified through audit can be dealt with at the intermediary level. Where investigation raises questions about whether incorrect bills are “knowingly” submitted, the self disclosure process may provide some mitigation of potential loss. Situations where the provider perhaps “should have known” raise more difficult issues of analysis.
The situation is also complicated because a potential whistle-blower may view a situation much differently than a provider who finds what it believes to be an innocent mistake through the audit process. A provider may sincerely believe that there was no “wrongdoing” and that a simple mistake has been identified. Finding such a mistake may actually be evidence that the provider’s compliance efforts are working. On the other hand, there is a whole legal profession out there now that is advertising for people to come forward with these types of mistakes. With potential recover under the False Claims Act of 3 times
Read more here: Health Law Blog
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