CMS Looks to Streamline Self-Disclosure Process

Patient self-referralIn an attempt to streamline the self-disclosure process, The Centers for Medicare and Medicaid Services (CMS) recently posted revisions to the Voluntary Self-Disclosure Protocol (SRDP), which allows providers of healthcare services and suppliers to self-disclose actual or potential violations of the federal physician self-referral law.

Beginning June 1, providers of services and suppliers must use the new highly detailed forms included in the OMB-approved collection instrument entitled CMS Voluntary Self-Referral Disclosure Protocol (SRDP) in order to utilize the SRDP.

The SRDP Disclosure Form requires disclosing parties to provide, not only general identification information such as the businesses’ name, address, national provider identifier, but also to address the “pervasiveness” of the noncompliance at issue. CMS defines pervasiveness as “how common or frequent the disclosed noncompliance was in comparison with similar financial relationships between the disclosing party and physicians.”

All voluntary Stark Law self-disclosures, other than those by physician-owned hospitals that fail to disclose physician ownership on a hospital’s public website or in any public advertisement, must be submitted using the new forms and financial worksheet.

Physician-owned hospitals must continue to report noncompliant conduct under separate special instructions issued by CMS. The special instructions are available and can be found by clicking here.

CMS notes that the SRDP “is intended to facilitate the resolution of only matters that, in the disclosing party’s reasonable assessment, are actual or potential violations of the physician self-referral law. Thus, a disclosing party should make a submission under the SRDP with the intention of resolving its overpayment liability exposure for the conduct it identified.”

Disclosures involving noncompliance with any other provision of the physician self-referral law, including disclosures involving mixed noncompliance with § 411.362(b)(3)(ii)(C) and noncompliance with any other provision of the physician self-referral law, should continue to follow the standard SRDP instructions.

As we wrote about in May 2016, CMS published a notice proposing revisions to its SRDP. Under the proposal, healthcare providers who use the SRDP have to provide the agency with a financial analysis of overpayments based on a six-year lookback period.

As an aside, CMS reported 102 disclosures were settled in 2016 with amounts of settlements ranging from as little as $80 to as much as nearly $2 million, for a total of $6.9 million. As of December 31, 2016, an additional 92 disclosures to the SRDP were withdrawn, closed without settlement or settled by CMS’ law enforcement partners.

The Health Law Offices of Anthony C. Vitale has extensive experience representing clients in voluntary disclosures, audits and overpayments and can represent your interests through all stages of the disclosure and refund process in an effort to achieve the most successful results. If you have any questions or concerns, contact us at 305 358-4500 or email us at info@vitalehealthlaw.com.