Policy & oversight
DOJ and HHS Open Six-Month Window for Healthcare Providers to Self-Report Civil Medicare Billing Violations
A new civil pilot program lets providers that may have overbilled Medicare resolve potential False Claims Act liability under fixed terms, separate from the criminal self-disclosure protocol announced the previous week.
By the Goodsurance editorial teamOctober 23, 2026
The Justice Department's Civil Division and the Department of Health and Human Services announced on October 22, 2026, a six-month Healthcare False Claims Act Self-Disclosure Pilot Program. The program creates a defined path for healthcare providers, suppliers, manufacturers, and health plans to voluntarily report potential civil violations of the federal False Claims Act, provided the violations were not already known to the government.
To participate, entities must disclose all relevant details, provide supporting documents, describe remedial steps taken, and repay alleged overpayments at a multiplier of between 1.25 and 1.6 times the amount identified. In exchange, they receive a civil release from False Claims Act liability. The HHS Office of Inspector General will not impose an exclusion or require a Corporate Integrity Agreement, and CMS will not revoke enrollment or billing privileges.
Providers that may have overbilled Medicare can now self-report civil billing violations under fixed repayment terms. The window runs six months from October 22.
The program is open to providers, suppliers, manufacturers, payors, and related entities whose products or services are paid with federal healthcare funds, including Medicare and Medicaid.
The announcement is separate from a unified criminal self-disclosure protocol that the DOJ National Fraud Enforcement Division and HHS-OIG announced on October 15, which streamlined reporting for potential criminal healthcare fraud. This new pilot covers civil False Claims Act matters only.
DOJ said the goal is to concentrate enforcement resources on providers that refuse to come forward voluntarily.
For Medicare beneficiaries, the program works indirectly: when providers self-report billing errors and repay overpayments under these terms, funds return to the Medicare trust fund more quickly than through a full government investigation. The pilot window runs for six months from October 22.
In plain words
Sometimes doctors, hospitals, and health companies charge Medicare for things they should not have. Usually the government only finds out after a long investigation. Now there is a new program where those providers can come forward on their own first. If a provider admits the billing problem, shows what happened, fixes it, and pays back what is owed with a penalty added on, the government will not remove them from Medicare or put them under special oversight. The program runs for six months. The government says this lets investigators focus on providers that refuse to cooperate.
Understand the basics first
Source: DOJ
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