The OIG has issued updated guidance on the agency’s exclusion authority, as announced by Inspector General Daniel Levinson at the HCCA’s 2016 Compliance Institute.
According to the new guidance, good-faith self-disclosures will place providers at the lower-risk end of the spectrum for an exclusion release without integrity obligations. As a result, providers have additional support for pursuing prompt self-disclosures to resolve potential non-compliance issues discovered in the course of internal investigations.
Although a compliance program is expected and does not affect the risk assessment, “[t]he absence of a compliance program that incorporates the U.S. Sentencing Commission Guidelines Manual’s seven elements of an effective compliance program indicates higher risk.”
These considerations, among others, will inform how the OIG exercises its authority when settling a civil or administrative healthcare fraud case, including whether to pursue “(1) exclusion; (2) heightened scrutiny (e.g., implement unilateral monitoring); (3) integrity obligations; (4) take no further action; or (5) in the case of a good faith and cooperative self-disclosure, release 1128(b)(7) exclusion with no integrity obligations.”
As providers identify potential non-compliance issues, including through their compliance departments’ internal reviews, the OIG’s guidance supports that proactive, voluntary corrective action should enhance the likelihood of a favorable resolution.