What if you suspect fraudulent activity at your own practice?

Physicians rely on the trust of multiple people, including patients, employees and members of the public. Unfortunately, some unscrupulous doctors abuse this trust to commit acts of fraud. However, there is sometimes a gray area where a trustworthy physician inadvertently commits unlawful activity.

If you suspect that you or another staff member accidentally violated the law, it may be in your best interest to voluntarily self-disclose this to the Office of Inspector General. The OIG has a set of protocol to follow that physicians can follow to potentially avoid or mitigate civil or administrative penalties.

How do I self-disclose problematic activity?

The office established a set of self-disclosure protocol for doctors. If you have engaged in a problematic relationship or participated in improper billing, you should:

  • Stop the problematic activity

Take steps to end the conduct as soon as possible. If this involves billing procedures, then stop filing the bills in question. If you have a conflict of interest or other problematic relationship, end it. Document the steps that you take to identify and halt the activity.

  • Return overpayments

Calculate any billing errors that caused you to overbill patients, clients or Federal health care programs. Return the overpayment to the correct parties.

  • Conduct an internal investigation

Performing an internal investigation to the best of your ability is crucial when submitting a self-report. It will help you and the OIG understand the scope of the problematic behavior. If you cannot complete the investigation before sending a submission, then they must complete the investigation within 90 days of submitting.

  • Submit a disclosure

The next step is to submit the self-disclosure. You can do this online via the OIG’s website, or by sending it through the mail. Your submission should include a statement on the details of the case, the Federal civil, criminal or administrative laws that were violated, the Federal health care programs affected by the conduct and an estimation of the damages.

Self-disclosing can mitigate liability

No doctor is perfect. The OIG understands that a well-intentioned, honorable physician could make an error that violates the law. Fortunately, the office is often willing to mitigate liability for physicians who come forward and report suspected fraud. This is meant to encourage doctors and their legal counsel to come clean about inadvertent misconduct without fear of punishment.

The outcomes of cases resolved under OIG self-disclosure protocol vary, but frequently involve civil monetary penalties. This may sound daunting, but remember that this may be much better than the penalties that would result if an outside party reported the fraudulent activity.

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