Defrauding Medicare? Here's How To Turn Yourself In

Have you claimed millions in Medicare reimbursements for fictional patients? Are you paying a kick-back to a local physician to direct Medicare patients your way?

If you want to make a clean breast of your illegal activities, the Office of Inspector General has made it easy for you. This week the OIG released the lastest draft of procedures for the Provider Self-Disclosure Protocol (SDP). The SDP is the process “for healthcare providers to voluntarily identify, disclose, and resolve instances of potential fraud involving the Federal health care programs,” according to the new draft of the document. “The SDP provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider’s liability under OIG’s civil monetary penalty authorities.”

The SDP was put into place in 1998, but this is the first time the entire protocol has been updated.

What possible motivation would anyone have to turn themselves in? As the SDP explains, there are four benefits to be considered:

1. You may avoid “integrity agreement obligations,” where, in essence, the OIG sits on your company’s shoulder for five years, including annual audits to make certain you are keeping your nose clean;
2. You may pay a smaller penalty than would result from a government-driven investigation.
3. Your indiscretion may not be immediately identified as an “overpayment,” requiring you to pay back all disputed funds within 60 days; instead you may be allowed to pay when you reach a settlement with the government.
4. The government will work with you, rather than against you, to reach a settlement.

OIG Provider Self-Disclosure Protocol can be downloaded here (PDF, registration required):  (You must be logged in to download this file. Don't have an account? Register for free and you'll be returned to this page.)