The Trump administration is rolling out a new pilot program for companies that voluntarily self-disclose False Claims Act violations.
The Department of Health and Human Services and Department of Justice will jointly oversee the six-month pilot, according to an announcement from HHS. If a company discloses a potential civil FCA violation through the pilot, they can resolve those claims "through a coordinated civil release from liability under the federal False Claims Act and certain HHS administrative authorities."
To meet the requirements of the pilot, a company must disclose all relevant details about the potential violations, as well as any documents that show the full nature and operations behind the disclosed conduct. Companies must also detail any remedies they have launched in response and make a repayment that's calculated under the pilot's terms.
The payment multiplier will depend on the length and scope of the violation, how timely the disclosure was, the involvement of senior leadership and the financial benefit to the company.
"Companies that identify and report potential violations should have a clear way to correct them, repay the government, and continue serving people in federal healthcare programs," said Centers for Medicare and Medicaid Services Administrator Mehmet Oz, M.D., in the announcement. "This pilot creates a defined path to accountability while helping CMS focus its enforcement resources on fraud."
In exchange for making the voluntary disclosures, the companies will receive a release from the DOJ for FCA violations, and the HHS Office of Inspector General will not subject the company to an exclusion or mandate a corporate integrity agreement to resolve the case.
In addition, CMS will not revoke the company's enrollment or billing privileges, and neither it nor OIG will hit them will civil monetary penalties, per the announcement.
"Voluntary self-disclosure is a powerful indicator of a company’s commitment to compliance and accountability," said Assistant Attorney General Brett Shumate of the Justice Department’s Civil Division in the agency's press release. “This pilot program offers a favorable resolution framework to companies that want to take responsibility for past conduct while allowing the Department to concentrate resources on those who deliberately exploit our healthcare system."
"But for companies unwilling to take accountability, the Civil Division, in partnership with whistleblowers, will root out the fraud," Shumate said.
The announcement of the pilot comes shortly after the DOJ revealed it would roll out a new policy that streamlines the process for healthcare organizations to disclose criminal fraud. Both that announcement and the new HHS pilot aim to reduce barriers that prevent companies from self-disclosure.
The White House has put a focus on rooting out fraud, waste and abuse across government, with healthcare a prime target for this effort. Much of the emphasis in federal rulemaking has been on addressing fraudulent or wasteful behavior.