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Understanding the how and why of self-reporting false claims

On Behalf of | Dec 15, 2021 | Firm News

It can be challenging to navigate compliance standards in the healthcare system. The rules tend to change often, and it can be difficult to instill the importance of following reporting protocols to staff.

The False Claims Act was initially designed to uncover fraud in healthcare claims. As the Act has developed, healthcare workers began seeing that, when possible, self-reporting reveals false claims faster. This allowed healthcare facilities to resolve fraudulent claims more directly. This year, there were updates to the self-reporting protocol process.

Here’s an overview of the updates to the self-reporting protocol (SDP) process and why it is important.

Why self-reporting is essential

False claims are expensive. Over the years, hundreds of millions of dollars have recovered from uncovering false healthcare claims.

In addition to restoring improperly used funds, self-reporting helps healthcare professionals maintain the healthcare system’s integrity.

Self-reporting process

Before this year’s updates, there was more than one method for self-reporting false claims incidents. However, the self-reporting process is now completed entirely through the Health and Human Services-Office of Inspector General (HHS-OIG) website.

When you access the portal for making a report, you will need information about the incident, such as:

  • Identifying information about the person(s) involved
  • A concise statement of the facts of the false claim
  • Federal programs affected by the conduct
  • List of Federal criminal, civil or administrative laws in question
  • Estimate of damages

There can be a significant amount of information you need to complete the reporting process. It is essential to seek help gathering the data if you are unsure what to do.

2021 updated requirements

In addition to requiring all reports to go through the HHS-OIG website, other updates include:

  • Statutory penalty amounts
  • Clarification for the Department of Justice to settle some SDP cases
  • Inclusion of damages for required disclosures

When you and your staff can support the False Claims Act by self-reporting fraud cases, you can ensure that you are providing quality care.