January 15, 2008
CMS is soliciting comments to assist in its development of a mandatory self-reporting regulation. Specifically, CMS is requesting comments concerning:
- How to define the types of offenses constituting "fraud or misconduct" (and specific examples of conduct that constitutes potential fraud or misconduct);
- Whether a formulation other than "fraud or misconduct" would better describe the offenses that should trigger reporting (e.g., violations of administrative, civil, and/or criminal authorities);
- What entities should be required to report (e.g., plan sponsors, first tier, and/or downstream entities);
- When an organization or sponsor should be required to self-report fraud or misconduct (e.g., upon initial discovery or after an opportunity for reasonable inquiry or due diligence); and
- How information should be reported to CMS (e.g., to MEDICs, to the CMS plan manager, or to the CMS central office).
CMS also has solicited any other comments or constructive feedback that would assist the agency in crafting a mandatory self-reporting requirement.
In recent discussions, the CMS Program Integrity group has reiterated the agency's interest in receiving industry feedback on these important considerations. Comments are due on or before February 4, 2008.
For additional information concerning CMS' request for comments, see the December 5th Final Rule with Comment Period.