DOJ: National Fraud Enforcement Division and the Department of Health and Human Services Announce Self-Disclosure Protocol for Criminal Health Care Fraud

• A single disclosure now covers both the Corporate Enforcement Policy and the Health Care Fraud Self-Disclosure Protocol.
• HHS-OIG updated its protocol to clarify that criminal conduct should be disclosed to the Department of Justice.

The DOJ’s National Fraud Enforcement Division and HHS-OIG issued a new policy clarifying that companies who voluntarily self-disclose potential criminal health care fraud only need to report to the DOJ’s Fraud Division. This streamlines the process, allowing companies to access both the DOJ’s Corporate Enforcement Policy and HHS-OIG’s Health Care Fraud Self-Disclosure Protocol without multiple submissions.

HHS-OIG also updated its Self-Disclosure Protocol to specify that criminal conduct should be reported to the DOJ, not just HHS-OIG. Companies disclosing only to HHS-OIG generally will not qualify for a DOJ declination, emphasizing the importance of reporting criminal matters directly to the Fraud Division.

• more than 6,200 defendants charged by the strike forces
• more than $45 billion amount billed by defendants to federal health care programs and private insurers

• Update internal reporting procedures to ensure all potential criminal health care fraud is disclosed to the DOJ Fraud Division’s Health Care Fraud Section.
• Review the updated HHS-OIG Self-Disclosure Protocol to confirm criminal conduct is routed to the DOJ, not solely to HHS-OIG.
• Train compliance staff on the new single-disclosure process to avoid missing eligibility for both the Corporate Enforcement Policy and the Health Care Fraud Self-Disclosure Protocol.

This policy change significantly simplifies the self-disclosure process for health care organizations by establishing a single point of contact for reporting potential criminal conduct. By eliminating the need for multiple disclosures to different agencies, compliance officers can ensure their organizations receive the full benefits of both the DOJ’s Corporate Enforcement Policy and HHS-OIG’s Self-Disclosure Protocol. This clarity reduces the risk of missed opportunities for leniency and encourages timely, transparent reporting, which is critical for mitigating enforcement actions and demonstrating a strong compliance culture.