DOJ, HHS-OIG Unify Healthcare Fraud Self-Disclosure Process
The Justice Department's National Fraud Enforcement Division and HHS Office of Inspector General issued a joint policy on October 15 allowing healthcare organizations to self-disclose potential criminal conduct, such as kickbacks, medically unnecessary billing, or concealing an excluded provider, to the Fraud Division alone. That single disclosure now confers benefits under both DOJ's Corporate Enforcement Policy and HHS-OIG's Health Care Fraud Self-Disclosure Protocol, eliminating the need for a separate HHS-OIG portal submission. HHS-OIG also clarified that its protocol covers only civil or administrative conduct; organizations disclosing solely to HHS-OIG will generally not qualify for a declination tied to criminal conduct. Hospitals and health systems uncovering potential fraud tied to Medicare or other federal programs should now route disclosures to the DOJ Fraud Division first to preserve credit under both regimes.