Once an organization or a firm voluntarily discloses its misconduct by itself, it’ll invite a lot of probing inquisition. The firm is given the burden to choose what to disclose and what not to disclose. Legal expert Lisa Manziel has however stated that many forget to think of where to make the disclosure. Lisa Manziel has been working with healthcare practitioners and firms for more than thirty years. She is a legal practitioner who specializes in business law and compensation problems at Manziel Law Offices. She further warned firms taking this step never to underestimate their decisions because this is a serious issue.
While most firms make these disclosures to the government, there is another entity they can disclose to. That is the DOJ(Department of Justice). However, no matter the entity you disclose it to, each has its advantages and disadvantages. It’s up to you to weigh the pros and cons and choose the better option.
Advantages of Self Disclosure to the Departments of Justice
Disclosing fraudulent activities in your healthcare firm to the department of justice has the following benefits.
FCA(Release from False Claims Act) Liability: In this case, the government will not take the person that discloses this to court for the act. This also includes the tripartite harms done and sanctions. The justice department constantly updates the false claim acts. While the government doesn’t update its false claim act. The person disclosing it to the government can ask for FCA clearance but it isn’t the normal compensation plan. If you want to get the clearance, the government must work hand-in-hand with the justice department. The department has the right to say no to the government collaboration. Whereas the department of justice automatically gets the government’s agreement and seal when the issue is being settled.
Might Significantly Reduce the Compensation Rate:
DOJ doesn’t have a specific settlement rate, unlike the government which demands almost twice the amount. DOJ states that the ultimate rate defendants can get shouldn’t surpass the amount given to the government as settlement. This includes investigative costs, loss of earnings, the damage incurred by the government, and so on. There are things the DOJ put into consideration when trying to settle. These are; how cooperative the discloser is and accepting to be responsible for the damages.
The Discloser can Pay Lower Multiplier with Additional Benefits:
As stated earlier, the disclosed doesn’t pay more unlike if it was disclosed to the government.
Disadvantages of Self-Disclosing to The Department of Justice
The government automatically postpones the need to announce and refund an overpayment with a 60-day ultimatum. The ultimatum starts once the overpayment is noticed. The DOJ doesn’t postpone this refund announcement.
The government agency consists of people who can comprehend the intricacies and issues surrounding healthcare fraud. It was established by the government to eradicate healthcare fraud.
Healthcare Fraud Self Disclosure Protocol
Before the amendment of the protocols, the government agency revealed its intention to change the protocols to the public. It requested input from medical practitioners and the public. They revised it to make the healthcare system a trustworthy one. Thereafter, they made another revision to replace the earliest amendment done to the protocol.
This protocol aims to make it easy for the disclosing parties to comply with the laid down requirements. There are liabilities given unto disclosing parties to pay compensations. These liabilities can be waived if they self-disclose fraudulent activities in good faith. They can also salvage their reputations against any civil actions taken or when the government decides to investigate them.
The time between the fraudulent act and disclosure, subject prerequisites, and the techniques for evaluating the damages are constant.
The fraud self-disclosing protocols laid down by the Office of the Inspector General are:
- The settlement money has been increased to meet the least compensation requirements. The amount was amended in the budget three years ago.
- Any firm willing to self-disclose should do so at the OIG website or virtual platform instead of writing letters.
- You can’t self-disclose healthcare grant fraud to OIG. An organization or individuals can neither report fraudulent acts involving government contracts. There is a separate government platform specifically made for that.
- The person or firm disclosing the fraud should include if they are bound by any agreement in the disclosure.
- The fraud disclosure is subject to self-disclosure protocol laws.
- The revised protocol states that sometimes, DOJ can be a participant in self-disclosing events and find solutions to the issue.
- The person revealing the fraud must state how the fraudulent acts have harmed the government, innocent individuals, and the organization. Furthermore, he must calculate them in monetary terms accordingly.
Conclusion
If you have evidence that your healthcare organization is involved in fraud and wish to self-disclose, go ahead. Choose whether you want to disclose to the government or the Department of Justice.