Health Law Daily Wrap Up, FRAUD AND ABUSE—OIG REPORTS: OIG clarifies provider self-disclosure protocol for healthcare fraud, (Oct 20, 2026)

By K. C. Salcedo

The extensive guidance clarifies eligibility of providers, the minimal content necessary for a disclosure report, and financial liability.

The Office of Inspector General (OIG) supplemented preexisting guidance on the Provider Self-Disclosure Protocol (SDP) for healthcare fraud, specifying: (1) the providers and the conduct deemed eligible for self-reporting; (2) the information that must be included in a submission to the OIG; and (3) the OIG’s determination of settlement to resolve the disclosing party’s liability. The guidance distinguishes eligible conduct from matters requiring other reporting channels (OIG Notice (Oct. 15, 2026)).

SDP eligibility. Parties eligible to use the SDP included all “health care providers, suppliers, or other persons that are subject to OIG’s [civil monetary penalty] authorities found at 42 C.F.R. Part 1003,” regardless of industry, specialty, or service type. Parties who submitted to the SDP (Disclosing Parties) and were subject to an ongoing government inquiry may be eligible as well, provided such disclosures were made in good faith.

Reportable conduct included all matters that “potentially violate Federal law for which [civil monetary penalties] are authorized.” In its SDP submission, the Disclosing Party must expressly state the laws, rules, and regulations that were violated. Parties who avoided or inadequately stated their admissions of potential violation may be subject to delayed review and resolution processes, or removal from the SDP.

Conduct deemed ineligible for the SDP included: (1) requests for OIG opinions; (2) disclosures of solely physician self-referral violations, which should instead be submitted to CMS’s Self-Referral Disclosure Protocol (SRDP); (3) disclosures for which other reporting processes exist, such as the OIG’s Grant Self-Disclosure Program or Contractor Self-Disclosure Program; and (4) federal crimes, which should instead be disclosed to the Department of Justice (DOJ).

Disclosure content generally. The Disclosing Party must conduct an internal investigation and include its findings in its submission to the OIG, which must specify a “concise statement of all details relevant to the conduct disclosed,” the federal laws potentially violated, the federal programs potentially affected, a detailed estimate of damages, and the disclosing party’s corrective actions, among other things.

False billing disclosure content. For disclosures of improper claims submitted to a federal health care program, the Disclosing Party must conduct a review to calculate and estimate the improper amounts paid by the applicable federal program and report its findings. The estimate should be derived from all of the affected claims, or “a statistically valid random sample of the claims that can be projected to the population of claims affected by the matter.” The OIG described further the parameters of determining sample sizes and other items that must be reported, such as data sources, personnel characteristics, and the qualifications of the personnel conducting the review.

Excluded persons disclosure content. For disclosures of employment of or contracting with those on the OIG’s List of Excluded Individuals and Entities, the Disclosing Party must include in its submission the excluded person or entity’s identity, job duties performed, the Disclosing Party’s screening process, and description of any corrective action to prevent recurring violations, among other things. The OIG stated it would use the costs of employing or contracting the excluded individual to estimate the applicable item or service’s value, which would later inform the OIG’s calculation of damages.

AKS and physician self-referral disclosure content. For disclosures of violations of the Anti-Kickback Statute (AKS) or physician self-referral laws, the Disclosing Party must make a clear acknowledgement of a potential violation of the AKS and, if applicable, physician self-referral law. Submissions with absent or inadequate acknowledgements were unacceptable. The disclosure must also include the specific conduct underlying the potential violation, the relationship between or among the parties, the payment arrangement, and time frames of the conduct, among other things. To calculate damages, the OIG would consider the Disclosing Party’s “estimate of the amount paid by Federal health care programs for the items or services associated with potential violations of the AKS and, if applicable, the physician self-referral law,” the total remuneration involved in the arrangement, and explanation of its purported value of the financial benefit under the arrangement, among other things.

Settlement. The OIG stated it would require minimum settlement amounts for self-disclosed matters, specifically $100,000 for kickback-related submissions, and $20,000 for all other matters. If the Disclosing Party claimed an inability to pay the settlement amount, the OIG would “require extensive financial information, including audited financial statements, tax returns, and asset records.” If the Disclosing Party refunded an overpayment relating to the SDP matter prior to its resolution, the OIG would credit the amount toward the settlement. The OIG, however, would not be bound by any amount “repaid outside the SDP process.”

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