HHS and the Department of Justice’s Civil Division have launched a six-month pilot program for healthcare companies that report themselves for potential civil violations of the False Claims Act.
Under the Healthcare False Claims Act Self-Disclosure Pilot Program, companies that meet the requirements can settle disclosed conduct through a coordinated civil release that covers the False Claims Act and certain HHS administrative authorities, according to an Oct. 22 news release shared with Becker’s.
To qualify, healthcare companies must:
- Reveal all relevant details of the potential violations;
- Provide documents that show the full nature and scope of the conduct;
- Detail remedial steps taken;
- Repay the government under the protocol, which applies a multiplier of 1.25 to 1.6
The multiplier depends on various factors, including how quickly the company provided disclosure, and the scope and duration of the misconduct, whether senior leadership was involved, the company’s financial benefit, and whether the company inherited the liability via a transaction but fixed the issue promptly.
In return, companies will get a Justice Department release for disclosing the conduct. As part of the resolution, the HHS Office of Inspector General will not impose exclusion or require a corporate integrity agreement. CMS will also not revoke billing or enrollment privileges, and neither CMS nor OIG will impose civil monetary penalties.
“Companies that identify and report potential violations should have a clear way to correct them, repay the government, and continue serving people in federal healthcare programs,” Mehmet Oz, MD, administrator for CMS, said in the release. “This pilot creates a defined path to accountability while helping CMS focus its enforcement resources on fraud.”
Healthcare companies have through April 22, 2027, to electronically report themselves. Incomplete or late submissions will not be reviewed, the release said.
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