The DOJ and HHS-OIG have simplified how healthcare organizations report potential criminal fraud — now, there's just one stop: the DOJ. The change removes the confusion of navigating multiple agencies and offers clearer incentives for companies that come forward voluntarily. Organizations that disclose, cooperate, and remediate can avoid prosecution; those that don't should expect consequences.
The Department of Justice (DOJ) and HHS Office of Inspector General (HHS-OIG) have jointly announced a streamlined policy for healthcare organizations to voluntarily self-disclose potential criminal fraud. Under the new rules, companies need to report only to the DOJ's Fraud Division — not both agencies — while still qualifying for the civil and administrative benefits that HHS-OIG's process offers, such as reduced monetary penalties and no corporate integrity agreement.
The move is designed to eliminate the bureaucratic complexity that previously discouraged organizations from coming forward. As Assistant AG Colin M. McDonald put it: "There is now one clear point of contact: DOJ's Fraud Division." The DOJ's National Fraud Enforcement Division, launched in April, now includes nine healthcare fraud strike forces across the country.
Legal experts, however, urge caution. Firms like Womble Bond Dickinson and Sidley note that the policy is a "one-way street" — disclosing only to HHS-OIG won't qualify for a DOJ declination. They also flag a notable gap: the False Claims Act and its enforcement arm remain outside this new framework.
Key Takeaways:
Why it matters: For healthcare organizations, this policy shift simplifies compliance decisions but raises the stakes — getting the disclosure process wrong could cost a company its chance at avoiding criminal prosecution.
