OIG Should Suspend 60-Day Repayment Rule For Self-Disclosed Overpayments, Groups Say

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The Department of Health and Human Services Office of Inspector General should suspend an obligation to report and return overpayments within 60 days for Medicare providers who voluntarily enter into the provider self-disclosure protocol, according to comment letters from industry stakeholders sent to the OIG before an Aug. 17 deadline.

The letters were in response to a notice the OIG published in the June 18 Federal Register soliciting comments and recommendations on how to revise the provider self-disclosure protocol (16 HFRA 473, 6/27/12).

In a letter dated Aug. 17, James Madera, executive vice president and chief executive officer of the American Medical Association, said suspending the 60-day repayment obligation would make the OIG's self-disclosure protocol consistent with the Centers for Medicare & Medicaid Services Self-Referral Disclosure Protocol.


“Suspending the statutory obligation to report and return overpayments within 60 days would allow the submitting provider, and other providers who may be implicated in the disclosure, an opportunity to engage with the OIG protocol staff without running up against the 60-day due date for repayment.”  


--James Madera, AMA EVP

Madera also said that failing to suspend the 60-day obligation could discourage providers from self-disclosing overpayments.

“Suspending the statutory obligation to report and return overpayments within 60 days would allow the submitting provider, and other providers who may be implicated in the disclosure, an opportunity to engage with the OIG protocol staff without running up against the 60-day due date for repayment,” Madera said.

The 60-day obligation should remain suspended until a provider reaches a settlement agreement with the OIG or is removed or withdraws from the self-disclosure protocol, Madera said.

Madera also said the OIG should work to protect the confidentiality of provider information contained in a self-disclosure.

“Providers who are contemplating disclosing information to the OIG through the protocol should not be dissuaded from doing so because of confidentiality concerns,” Madera said.

Clarifying Appropriate Disclosures.

In an Aug. 16 letter, Charles N. Kahn III, president and CEO of the Federation of American Hospitals, also supported suspending the 60-day rule, urging the OIG “to supplement its standard letter to providers with additional language reflecting this approach to tolling the overpayment refund timeframe.”

Kahn also said the OIG should clarify whether settling a potential Stark law violation through the CMS self-disclosure protocol resolves all Stark issues. The Stark law prohibits physician referrals of Medicare or Medicaid patients to facilities with which the physicians have a financial relationship.

In 2009, the OIG said it no longer would accept self-disclosures focused solely on Stark law issues unless the disclosure also involved a “colorable anti-kickback statute violation.”

“Our overarching concern is that hospitals not be unreasonably burdened when disclosing a situation that implicates both the Stark statute and the CMP [civil monetary penalties] Statute,” Kahn said in his letter. “We believe strongly that where similar facts and parties are involved, a single disclosure should be appropriate, even if one of the arrangements does not have a colorable anti-kickback issue.”

FAH's letter included several additional recommendations, including asking the OIG to:

• do away with imposing penalties on providers in cases where no violations have been found;

• allow providers to consult with OIG staff on any potential self-disclosure settlement; and

• clarify whether hospitals that are operating under a corporate integrity agreement (CIA) can enter into the self-disclosure protocol.


Consolidated Self-Disclosure Protocol.

James G. Sheehan, chief integrity officer for the New York City Human Resources Administration (HRA), said the OIG should consolidate its provider self-disclosure protocol into one document.

“In order to simplify the SDP and make instructions clear, OIG should consolidate all documents into one comprehensive guide,” he said in an Aug. 16 letter. “Consolidation will be especially helpful for those entities considering disclosure that have yet to retain knowledgeable players.”

Sheehan, a former federal prosecutor and inspector general for the New York Medicaid program, said information on the OIG's self-disclosure protocol is spread out over three letters as well as a link to the Federal Register.

Sheehan also recommended suspending the 60-day repayment obligation, saying it would encourage more providers to enter into the protocol.

HRA also recommended publishing all disclosures after a settlement has been reached, as well as committing to a time frame for handling a provider's self-disclosure.

Sheehan said the OIG “should indicate when a provider will get accepted or rejected from the SDP and how long the OIG's resolution process will last.”

Sheehan also said the self-disclosure protocol should guarantee that all disclosures be treated equally, adding that the OIG should be flexible in regard to any payments associated with a settlement.

“Much like the Department of Justice, OIG should affirmatively state that the provider's ability to pay, and if a public entity, the impact on the organization's mission will be taken into account and should specify the process for doing so,” Sheehan said.

Streamlining Protocol.

Another comment letter, from Dianne J. De La Mare, vice president of legal affairs for the American Health Care Association, said that streamlining the self-disclosure protocol by eliminating unnecessary questions could help encourage provider participation and quicken the overall process.

“While originally intended to expedite resolution of potential fraud matters by shifting the investigative burden to disclosing providers, self-disclosures under the SDP often are anything but 'speedy,' even though OIG states that the SDP can 'diminish the time it takes before the matter can be formally resolved,'” De La Mare said in a letter Aug. 11 to OIG.

De La Mare also said the OIG should:

• clarify the types of disclosures appropriate for the OIG protocol and those that should be submitted to a provider's Medicare Administrative Contractor;

• establish a time frame for resolving a provider's disclosure; and

• clarify whether providers may face a CIA based on their disclosure.


By James Swann  

The AMA comment letter is at http://op.bna.com/hl.nsf/r?Open=jswn-8xdkuz.

The FAH comment letter is at http://op.bna.com/hl.nsf/r?Open=jswn-8xdkvh.

The NY HRA comment letter is at http://op.bna.com/hl.nsf/r?Open=jswn-8xdkw4.

The AHCA comment letter is at http://op.bna.com/hl.nsf/r?Open=jswn-8xdktt.

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