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Elizabeth M. Whitehorn, Director

Provider Notice Issued 08/23/2017

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Date:  August 23, 2017

To:     Participating Medical Assistance Program Vendors

Re:     Self-Disclosure Protocol

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As a result of Public Act 097-0689, referred to as the Save Medicaid Access and Resources Together (SMART) Act, the Department of Healthcare and Family Services (the Department) is required to establish a protocol to enable health care providers to disclose an actual or potential violation of Medical Assistance (Medicaid) program requirements.  The Department Office of Inspector General (the OIG) “self-disclosure protocol” establishes a voluntary disclosure process that providers may utilize upon detection of receipt of an overpayment from the Department.  The self-disclosure protocol will also assist providers to comply with overpayment detection and repayment obligations under the federal Patient Protection and Affordable Care Act.

The self-disclosure protocol is intended to establish a fair, reasonable, and consistent process that is mutually beneficial for both the Department and the disclosing provider. The OIG recognizes that the situations which are appropriate for referral to the protocol will vary significantly; therefore, the protocol is written in general terms to allow providers and the OIG the flexibility to address the unique aspects of each matter.  Each disclosure is distinct and will be reviewed, assessed, and verified by the Department on an individual basis.

In exchange for the provider’s good-faith self-disclosure and ongoing cooperation, the Department may offer benefits to the provider. These benefits may include the waiver or reduction of interest payable on the overpayment, extended repayment terms, and waiver of some or all applicable penalties or sanctions. All self-disclosures received that do not comply with this protocol will be returned to the Provider for compliance based upon the current Department protocols.

 

 

Bradley Hart

Inspector General