CMS Publishes Stark Act Self-Referral Disclosure Protocol (SRDP)

Last week the Centers for Medicare and Medicaid Services (CMS) published a Medicare self-referral disclosure protocol (SRDP) as required by the Patient Protection and Affordable Care Act (PPACA) health reform legislation. This protocol describes the process for providers and suppliers to self-disclose actual or potential violations of the Stark physician self-referral statute. The Stark Act provides for civil penalties up to $15,000 per improper claim. The new SRDP authorizes CMS to reduce the penalties assessed against a provider for Stark Act violations where the provider self-reported its conduct. In making this reduction, CMS will consider the following factors:

The nature and extent of the improper or illegal practice
The timeliness of the self-disclosure;
The cooperation in providing additional information related to the disclosure;
The litigation risk associated with the matter disclosed; and
The financial position of the disclosing party

Although CMS will at least consider these factors in each self-disclosure, it is not bound to reduce any amounts due and owing.

The new disclosure process requires a provider to e-mail an initial electronic disclosure to CMS and a mail a secondary hard copy disclosure to CMS headquarters. Currently providers must submit disclosures the later of 60 days after the date the overpayment was identified or the date of any corresponding cost report is due. The SRDP now suspends this 60-day requirement until a settlement agreement is reached, the provider withdraws from the SRDP, or CMS removes the provider from the SRDP.

The SRDP applies to all providers and suppliers, known as "disclosing parties," and is not limited to any particular industry, medical specialty, or type of service.

Please contact Mark Bina if you have any questions on the new SRDP or other issues involving health care fraud and abuse issues.