Self-Disclosure Protocol

Sample Solution

Self-Disclosure Protocol for [Organization Name]

Introduction

This policy outlines the procedures for self-disclosure of potential violations of federal and state healthcare laws and regulations at [Organization Name]. Self-disclosure is the process by which the organization voluntarily discloses to the OIG and/or other appropriate authorities potential violations of overpayment, false claims, or other non-compliance with applicable laws and regulations.

Full Answer Section

Purpose

The purpose of this policy is to:

• Promote ethical and compliant behavior within the organization.
• Identify and address potential violations promptly and effectively.
• Minimize the potential for financial penalties and other negative consequences.
• Foster a culture of transparency and accountability.

Scope

This policy applies to all employees, agents, and contractors of [Organization Name]. It covers all activities related to the provision of healthcare services, including billing, coding, claims submission, and financial reporting.

Definitions

• Overpayment: Any amount of money received for healthcare services that exceeds the amount to which the organization is entitled under applicable law and regulation.
• False Claim: A claim for payment submitted to a government healthcare program that is false or misleading, in whole or in part.
• Non-compliance: Any violation of applicable federal or state healthcare laws and regulations, including but not limited to Stark, Anti-Kickback Statute, and HIPAA.
• OIG: The Office of Inspector General of the U.S. Department of Health and Human Services.

Procedure for Self-Disclosure

1. Identification of Potential Violation: Any employee, agent, or contractor who becomes aware of a potential violation of this policy should immediately notify the Compliance Officer.
2. Investigation: The Compliance Officer will investigate the potential violation to determine the scope and nature of the violation, the amount of potential overpayment or false claim, and the root cause of the violation.
3. Disclosure Decision: The Compliance Officer, in consultation with legal counsel and senior management, will determine whether to self-disclose the potential violation to the OIG and/or other appropriate authorities.
4. Self-Disclosure Submission: If a decision is made to self-disclose, the Compliance Officer will prepare and submit a self-disclosure report to the OIG and/or other appropriate authorities. The report will include, at a minimum:
   • A description of the potential violation.
   • The date(s) of the violation.
   • The amount of potential overpayment or false claim.
   • The root cause of the violation.
   • The corrective actions taken or planned to be taken to prevent future violations.
5. Cooperation with Authorities: [Organization Name] will fully cooperate with the OIG and/or other appropriate authorities in their investigation of the potential violation. This includes providing all requested information and documents and making employees available for interviews.
6. Corrective Action: [Organization Name] will take appropriate corrective action to address the root cause of the violation and prevent future violations. This may include revising policies and procedures, providing additional training to employees, and implementing new monitoring and control procedures.

Compliance with OIG Self-Disclosure Information Requirements

This self-disclosure protocol complies with the OIG's Self-Disclosure Information requirements in the following ways:

• It establishes clear and consistent procedures for identifying, investigating, and disclosing potential violations.
• It requires prompt reporting of potential violations to the Compliance Officer.
• It ensures that self-disclosure reports are accurate, complete, and timely.
• It demonstrates a commitment to cooperating with the OIG and/or other appropriate authorities in investigations.
• It requires the implementation of appropriate corrective action to address the root cause of the violation and prevent future violations.

Training and Education

[Organization Name] will provide training and education to all employees, agents, and contractors on its self-disclosure policy and procedures. The training will cover the following topics:

• The importance of ethical and compliant behavior.
• How to identify potential violations.
• The procedures for reporting potential violations.
• The consequences of non-compliance.

Retaliation

[Organization Name] prohibits retaliation against any employee, agent, or contractor who reports a potential violation in good faith.

Effective Date

This policy is effective immediately.

Contact Information

For any questions or concerns regarding this policy, please contact the Compliance Officer at [Compliance Officer Contact Information].

Appendices

• Appendix A: Self-Disclosure Report Form
• Appendix B: FAQs

Disclaimer

This policy is intended to provide general guidance and does not constitute legal advice. It is recommended that you consult with legal counsel for specific advice on self-disclosure matters.