DOJ and HHS-OIG Unify Health Care Fraud Reporting Into a Single Disclosure

The Justice Department's National Fraud Enforcement Division and the HHS Office of Inspector General announced October 15 that health care organizations no longer need to file separately with both agencies when voluntarily disclosing potential criminal misconduct. Under the updated process, a single submission to the DOJ Health Care Fraud Section qualifies the disclosing entity for protections under both the DOJ Corporate Enforcement Policy and the HHS-OIG Self-Disclosure Protocol. Before the change, a company that reported only to HHS-OIG generally would not have been credited with making a voluntary self-disclosure to the Justice Department, which could have affected its eligibility for a declination of criminal charges. The policy covers conduct affecting federal health care programs such as Medicare and Medicaid, including billing for medically unnecessary services, unlawful kickbacks, and concealment of excluded providers. The DOJ Health Care Fraud Section operates nine strike forces across the country and since 2007 has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than 45 billion dollars. Officials said the streamlined process is designed to reduce barriers to voluntary disclosure and improve recovery of program funds. Disclosures may be submitted to corporate.enforcement@usdoj.gov.