New Healthcare Self-Disclosure Pilot Program Rewards Early Action

Healthcare organizations have a new incentive to detect and address potential misconduct before the government discovers it. The U.S. Department of Justice and the U.S. Department of Health and Human Services (HHS) announced a six-month Healthcare False Claims Act Self-Disclosure Pilot Program offering qualifying companies a coordinated pathway to resolve potential civil False Claims Act liability and certain HHS administrative exposure. Early detection, timely escalation, and documented remediation strengthen an organization’s ability to pursue this opportunity. Waiting for a government inquiry may foreclose it.

Participation requires more than reporting billing errors. Companies must disclose all relevant facts, provide supporting documentation, describe corrective actions, and make repayment under the program’s terms. A multiplier of 1.25 to 1.6 applies to the base self-disclosure repayment. Factors affecting the multiplier include the timeliness of disclosure, the duration and scope of the misconduct, senior leadership involvement, financial benefit, and prompt correction of inherited liability.

For qualifying companies, resolution includes a civil release covering the disclosed conduct. HHS’s Office of Inspector General would not impose exclusion or require a corporate integrity agreement as part of the resolution. The Centers for Medicare & Medicaid Services would not revoke enrollment or billing privileges. Neither agency would impose civil monetary penalties for the resolved conduct.

These benefits are conditional—not blanket immunity. The pilot covers potential violations previously unknown to the federal government. Matters already known to the government may qualify for other self-disclosure or cooperation credit, but not resolution under this pilot. Potential criminal conduct requires separate consideration under the applicable criminal disclosure framework.

10 Suggested Actions for Compliance Officers

1. Brief leadership and board compliance committees on the new pilot program.
2. Assess whether reporting channels, billing audits, investigations, and escalation protocols detect concerns promptly and generate reliable documentation.
3. Review unresolved audit findings and complaints and take action to resolve open issues.
4. Do not assume that every overpayment constitutes fraud or that participation guarantees acceptance.
5. Assign corrective-action owners and independently verify that remediation actions are effective in preventing recurrence.
6. Involve legal counsel promptly when potentially disclosable issues arise, preserve relevant records, and address underlying causes—not just isolated errors.
7. When potentially disclosable issues are identified, quickly establish a rapid-response team that includes legal, finance, and revenue-cycle leaders.
8. Work with finance to quantify affected claims and potential repayment, documenting calculation methods and assumptions.
9. Base disclosure decisions on facts, eligibility criteria, and legal obligations.
10. Ensure that legal counsel assesses separate reporting and repayment deadlines; do not assume that participation suspends them.

For more information on how government enforcement initiatives can impact your organization, contact Richard Kusserow at [email protected].

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.