DOJ and HHS-OIG Announce Unified Self-Disclosure Protocol for Criminal Health Care Fraud

What this means for your practice

This new unified self-disclosure protocol represents a significant development for healthcare businesses, including telehealth brands, medspas, dental practices, and chiropractic offices that participate in federal healthcare programs. Previously, organizations discovering potential criminal conduct faced uncertainty regarding whether to disclose to DOJ or HHS-OIG, or both, to secure the benefits of respective policies. The clarified 'one-stop shop' approach means that a single, timely disclosure of criminal conduct to the DOJ's Fraud Division will now automatically qualify a company for the benefits offered by both agencies. This reduction in administrative complexity should encourage more voluntary disclosures, potentially leading to more predictable and favorable outcomes for companies that proactively address compliance failures. Failure to utilize this pathway when warranted, or disclosing only to HHS-OIG for criminal matters, could result in missing out on critical DOJ benefits, including potential declinations.

WASHINGTON, D.C. — In a significant move aimed at streamlining compliance and encouraging transparency, the Department of Justice's National Fraud Enforcement Division (Fraud Division) and the Department of Health and Human Services Office of Inspector General (HHS-OIG) have jointly announced a new policy establishing a unified self-disclosure protocol for potential criminal health care fraud. This policy clarifies that companies seeking to voluntarily self-disclose potential criminal conduct related to health care need only to report to the Fraud Division to receive the benefits of both the Department of Justice’s Corporate Enforcement Policy and HHS-OIG’s Health Care Fraud Self-Disclosure Protocol (SDP).

Eliminating Bureaucratic Barriers

Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division emphasized the intent behind the new policy, stating, “Companies that discover fraud within their own operations should not have to navigate a maze of agencies before reporting it.” The policy directly addresses past confusion regarding whether multiple disclosures were necessary for potentially criminal conduct. Now, there is one clear point of contact: the DOJ’s Fraud Division. This unified approach is designed to eliminate obstacles that may slow disclosures, providing a more direct and predictable pathway for companies committed to identifying and remedying misconduct.

HHS Inspector General T. March Bell echoed this sentiment, highlighting the importance of the OIG Self-Disclosure Protocol as a critical tool for promoting accountability and integrity within the healthcare system. “We encourage companies to come forward and disclose criminal conduct to the Justice Department, and we are committed to extending the benefits of the HHS-OIG Self-Disclosure Protocol to those who do,” Bell stated. The OIG SDP is designed to facilitate timely corrective action and reduce future risks by encouraging ethical conduct.

The New Process: One Disclosure for Dual Benefits

Under the newly announced policy, a company that voluntarily self-discloses criminal conduct affecting a federal health care program directly to the Fraud Division’s Health Care Fraud Section will automatically receive the benefits of HHS-OIG’s SDP. This means no additional direct submission through the HHS-OIG portal is necessary for matters involving criminal conduct.

Crucially, HHS-OIG has simultaneously updated its own SDP to clarify the reverse situation. The HHS-OIG SDP primarily covers conduct that may violate civil or administrative law. The updated protocol now explicitly states that criminal conduct should be disclosed to the Department of Justice. A company that discloses only to HHS-OIG for matters involving criminal conduct generally will not be considered to have made a voluntary self-disclosure to the Department of Justice and, consequently, will not qualify for a declination on that basis. Therefore, companies seeking the benefits of both programs should direct potentially criminal conduct to the Fraud Division first.

Scope of Covered Conduct

The policy covers a broad range of potential misconduct that often results in criminal, civil, or administrative consequences. Examples provided include illegal kickbacks, schemes to bill Medicare for medically unnecessary services, and schemes concealing an excluded provider. The unified protocol is intended to simplify the decision-making process for companies facing such overlapping legal exposures, providing a single, clear avenue for disclosure.

Historical Context and Enforcement Focus

The announcement follows the recent creation of the Fraud Division by the Department of Justice, which is tasked with investigating and prosecuting those who commit fraud against the American people. This initiative aligns with broader government efforts to combat fraud, waste, and abuse within Federal benefit programs. The Fraud Division’s Health Care Fraud Section, with its nine strike forces operating across the country, has a long-standing record of enforcement. Since 2007, these strike forces have charged over 6,200 defendants involved in schemes that collectively billed federal health care programs and private insurers more than $45 billion. This new policy reinforces the Department's commitment to robust enforcement while providing a structured pathway for companies to demonstrate good faith and mitigate potential penalties through proactive disclosure and cooperation.

How to Disclose

Self-disclosures of potentially criminal conduct may be reported to the Fraud Division via email at [email protected]. This dedicated channel is the primary point of contact for companies wishing to engage with the new unified self-disclosure protocol.

Key Facts

Frequently Asked Questions

Where should my practice disclose potential criminal health care fraud to receive the most benefits?

Your practice should disclose potential criminal health care fraud directly to the Department of Justice's (DOJ) National Fraud Enforcement Division. This single disclosure will allow you to receive the benefits of both DOJ's Corporate Enforcement Policy and HHS-OIG's Self-Disclosure Protocol (SDP).

What happens if I only disclose potential criminal conduct to HHS-OIG?

If you disclose potential criminal conduct only to HHS-OIG, you generally will not be considered to have made a voluntary self-disclosure to the Department of Justice and therefore will not qualify for DOJ's benefits, such as a potential declination.

What types of conduct are covered by this new unified protocol?

The protocol covers conduct that may result in criminal, civil, or administrative consequences, such as illegal kickbacks, schemes to bill Medicare for medically unnecessary services, or schemes concealing an excluded provider.

What are the benefits of self-disclosing through this new process?

By disclosing potential criminal conduct to the DOJ Fraud Division, your company can receive the clear and predictable benefits of both DOJ's Corporate Enforcement Policy and HHS-OIG's SDP, which are designed to encourage timely corrective action, reduce future risk, and demonstrate a commitment to ethical conduct.

What is the contact information for making a self-disclosure under this new policy?

Self-disclosures of potentially criminal conduct should be reported to the Fraud Division via email at [email protected].

Source: DOJ — National Fraud Enforcement Division and the Department of Health and Human Services Announce Self-Disclosure Protocol for Criminal Health Care Fraud · Thu, 15 Oct 2026 12:00:00 +0000