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HHS and the Justice Department have opened a six-month pilot for healthcare companies to voluntarily report and resolve certain civil False Claims Act violations. Home-based care experts say the program may clarify how providers can address billing problems, but repayment costs and exposure for smaller agencies remain concerns. The pilot does not cover criminal Anti-Kickback Statute matters.
The U.S. Department of Health and Human Services and the Department of Justice have launched a six-month pilot allowing healthcare companies, including home-based care providers, to voluntarily disclose and resolve certain civil violations of the False Claims Act. The program sets out a coordinated process for addressing disclosed conduct, but industry representatives say the cost of repayments and the risks for smaller providers remain unresolved concerns.
Called the Healthcare False Claims Act Self-Disclosure Pilot Program, the initiative allows healthcare companies to report civil conduct involving alleged false claims to the government. HHS and DOJ said the pilot offers a coordinated civil release of liability under the False Claims Act and certain HHS administrative authorities. It runs for six months, with an end date of April 22, 2027, according to the Home Health Care News report.
The False Claims Act makes entities that knowingly submit, or cause the submission of, false claims liable for triple the government’s damages, plus an inflation-linked penalty, according to DOJ. The pilot provides a process for companies that voluntarily disclose conduct to resolve certain civil liability; the source material does not say that disclosure removes all potential financial consequences.
Monica Cutia, vice president of clinical operations at HealthView Home Health & Hospice, told Home Health Care News that internal audits at her company more often find documentation problems than fraud. Examples she cited include late certifications and face-to-face notes that do not meet all CMS billing requirements. She said the pilot could offer a clearer route for providers that identify patterns of billing errors, while emphasizing that the program is limited to civil matters.
A Defined Route for Billing Disclosures
For home-based care organizations, the pilot could make it easier to decide what to do after internal audits uncover recurring documentation or billing problems. Cutia said that previously providers could correct an issue and repay what they believed was owed without knowing what would follow if they reported a pattern. She described the pilot as setting out a number and timeline and said it would not involve a Corporate Integrity Agreement under the process she discussed.
The distinction matters because a Corporate Integrity Agreement can impose compliance obligations as part of a civil settlement. The Home Care Association of America (HCAOA) said the pilot may let well-meaning providers address civil False Claims Act liability without facing exclusion from federal programs, a Corporate Integrity Agreement or CMS enrollment revocation. These are the association’s stated expectations for the program, not a guarantee that every company that discloses will avoid those outcomes.
Small agencies may have less capacity to absorb repayments or penalties. HCAOA raised concern that the repayment multiplier could burden small, community-based providers with limited reserves and urged HHS and DOJ to consider waivers. The source report does not specify whether such waivers will be available.
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Civil Billing Rules and Criminal Exclusions
The pilot addresses certain civil False Claims Act matters, not every type of healthcare compliance risk. Cutia warned that conduct involving referrals—such as paying for admissions, providing free staffing or supplies to a facility, or medical director contracts that do not reflect the work performed—may fall under the Anti-Kickback Statute. She said that statute is criminal and is outside the pilot’s scope.
Cutia said the program may be most useful to providers with internal audit capacity and enough scale to identify and act on compliance issues. She also pointed to organizations buying or selling healthcare agencies, where known potential liabilities can affect a buyer’s financial exposure. Her comments reflect an industry operator’s assessment, not an official description of eligibility or a guarantee that the pilot resolves successor liability.
HCAOA, which the report describes as representing more than 5,000 home care agencies, supports the initiative and said it hopes officials will consider extending it or making it permanent after the scheduled end date, if appropriate.
“Companies that identify and report potential violations should have a clear way to correct them, repay the government and continue serving people in federal healthcare programs.”
— CMS Administrator Dr. Mehmet Oz, in a Thursday statement
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Repayment Terms and Eligibility Questions
The available details do not establish how the pilot will calculate repayment amounts in individual cases, which disclosures will qualify, or whether companies can receive waivers from the False Claims Act’s damages multiplier. HCAOA has called for possible waivers and for repayment to be limited to fraudulent transactions, but the source report does not say that HHS or DOJ has adopted those proposals.
It is also unclear how the agencies will assess disclosures involving documentation errors or how the process will affect a provider’s obligations beyond the civil release described for the pilot. The program does not cover criminal Anti-Kickback Statute conduct, according to Cutia’s account. Providers should not assume that reporting a matter through this process resolves separate criminal or administrative exposure.
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Pilot Runs Through April 2027
The pilot is scheduled to run until April 22, 2027. Providers will be watching for further guidance on how to submit disclosures, how the government will assess repayment and what relief may be available for smaller organizations. The source report does not provide a detailed application process or say when additional guidance will be issued.
HCAOA says it would like officials to consider extending the program or making it permanent if the pilot proves appropriate. Whether HHS and DOJ will do so, or change the repayment terms in response to industry concerns, remains open. For now, the program’s stated scope is limited to voluntary disclosures of certain civil False Claims Act violations during the pilot period.
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Key Questions
What does the new self-disclosure pilot allow?
It allows healthcare companies to voluntarily report certain civil False Claims Act violations and seek a coordinated resolution involving civil liability and some HHS administrative authorities.
How long will the pilot run?
The pilot lasts six months and is scheduled to end April 22, 2027.
Does the pilot cover Anti-Kickback Statute cases?
No. Cutia said the pilot is civil only and does not cover criminal Anti-Kickback Statute matters, including the referral-related examples she described.
Are providers guaranteed to avoid repayment penalties or other consequences?
No such guarantee is established in the available details. The False Claims Act can impose triple damages and an inflation-linked penalty, while HCAOA has raised concerns about repayment burdens and asked officials to consider waivers.
Could the program continue after April 2027?
HCAOA has said it hopes HHS and DOJ will consider an extension or permanent program if appropriate. The agencies’ plans after the scheduled end date have not been stated in the source material.
Source: rss
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