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Healthcare Practice Settles CMS Overbilling Matter With OIG’s Self-Disclosure Protocol.

Should we “self disclose” is an intimidating question for any healthcare practice that experiences a legal misstep. MacDonald Illig’s healthcare attorneys guided a practice through each step of this analysis and with the practice’s self-disclosure submission to the United States Department of Health and Human Services Office of Inspector General, as part of the self-disclosure protocol.

As a first step, our attorneys assisted the practice with its investigation into an incorrect billing methodology that resulted in substantial overpayments from CMS over a period of years. After making the determination that, yes, this was appropriate for a self-disclosure, we worked with the practice to calculate how much the practice had received in overpayments and the penalties likely to be imposed under the Civil Money Penalty Law. We carefully and thoroughly drafted a self-disclosure submission, which included the facts of the particular situation, the estimated overpayments, remedial efforts that have been implemented to prevent similar situations going forward, and other relevant information.

Ultimately, by utilizing the self-disclosure protocol, and providing well-prepared, thought out, and complete information to OIG, we were able to assist the practice in reaching a favorable settlement agreement with OIG. The settlement amount was consistent with our projections and included a release of liability from OIG for overbillings related to facts disclosed.

With the assistance of MacDonald Illig’s healthcare attorneys, the practice was able to move forward with the peace of mind that the matter had been resolved.