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HHS and the Justice Department have launched a six-month pilot allowing healthcare companies to voluntarily disclose and resolve certain civil False Claims Act violations. Home-based care providers say the process may clarify how to address billing problems, but repayment costs, the program’s limited duration and its exclusion of criminal conduct remain concerns.
The U.S. Department of Health and Human Services and the Justice Department have launched a six-month pilot giving healthcare companies, including home-based care providers, a formal route to report and resolve certain civil False Claims Act violations. Industry representatives say the process could clarify how providers should handle billing problems found in internal audits, but concerns remain about repayment costs and financial exposure, particularly for smaller organizations.
Called the Healthcare False Claims Act Self-Disclosure Pilot Program, the initiative allows companies to voluntarily disclose civil violations and seek a coordinated release of liability under the False Claims Act and some HHS administrative authorities. The agencies announced the program on Thursday. The pilot is scheduled to run for six months, ending April 22, 2027.
The False Claims Act covers knowingly submitting, or causing the submission of, false claims to the government. The Justice Department says liability can include triple the government’s damages and an inflation-linked penalty. The pilot describes a route to resolve disclosed conduct; it does not remove the underlying legal requirements or apply to every kind of alleged misconduct.
Monica Cutia, vice president of clinical operations at HealthView Home Health & Hospice, told Home Health Care News that internal audits at her company rarely reveal fraud. Problems more often involve late certifications or incomplete documentation that can affect billing. She said providers previously lacked a clear answer about what would follow if they reported a recurring problem. Cutia also said the prospect of a Corporate Integrity Agreement—a compliance arrangement tied to a civil settlement—could weigh more heavily on providers than repayment itself.
A Defined Route for Billing Corrections
For home health, hospice and other home-based care operators, the pilot could make it easier to decide how to respond when an audit identifies a pattern of billing errors. A stated process may help providers weigh disclosure, repayment and compliance obligations with counsel, rather than relying on informal expectations. That is particularly relevant to organizations that already have audit systems and compliance staff but are unsure how the government will treat a voluntary report.
The potential benefit is not the same for every provider. The Home Care Association of America, which represents more than 5,000 home care agencies, supports the initiative but warned that repayment multipliers could burden small, community-based providers with limited reserves. It urged HHS and DOJ to consider waivers and to require repayment tied to fraudulent transactions. Those are the association’s recommendations, not announced features of the pilot.
The program also matters to organizations acquiring or selling agencies. Cutia told Home Health Care News that buyers may use a defined disclosure process to address known liabilities inherited through a transaction. The details of how the pilot will apply to particular deals have not been established in the source material, so providers and prospective buyers will need to evaluate individual circumstances with legal and compliance advisers.
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Civil Claims, Not Criminal Conduct
The pilot focuses on civil False Claims Act liability and certain HHS administrative authorities. It should not be read as a general amnesty or as a change to all healthcare enforcement. Cutia cautioned that conduct involving referrals—such as paying for admissions, providing free staffing or supplies, or contracts that do not reflect actual work—may raise issues under the Anti-Kickback Statute, which she described as criminal and outside the pilot.
CMS Administrator Dr. Mehmet Oz said the program is intended to give companies a way to correct disclosed conduct and repay the government while allowing CMS to focus enforcement resources on fraud. The HCAOA likewise said the process could let well-meaning providers address civil liability without exclusion from federal healthcare programs, a Corporate Integrity Agreement or CMS enrollment revocation. Those outcomes are described by the speakers as potential benefits; the source does not establish that every disclosure will avoid such consequences.
“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.”
— Dr. Mehmet Oz, CMS administrator
Costs and Eligibility Still Unclear
The source report does not specify the exact repayment calculations, how the agencies will assess individual disclosures, or what documentation providers must submit. It also does not describe how frequently a disclosure will lead to a release of liability or which administrative consequences may still apply. These details matter because the False Claims Act can carry treble damages and additional penalties, while the association says the repayment multiplier could strain small providers.
The pilot is temporary, and the agencies have not announced in the source material whether it will be extended or made permanent. It is also unclear how the agencies will distinguish ordinary documentation errors from knowing false claims in specific cases. The program is limited to civil matters within its scope; it does not cover criminal conduct such as the Anti-Kickback Statute issues Cutia identified.
Providers Watch the Pilot Window
Providers are expected to assess the pilot against their existing audit and compliance processes during its six-month operating period. Organizations that identify potential violations will need to determine whether their conduct falls within the program and what disclosure and repayment obligations may apply. The source report does not provide a detailed agency timetable for decisions or explain how quickly disclosures will be resolved.
The HCAOA has asked HHS and DOJ to consider extending the program or making it permanent after its scheduled April 22, 2027 end date, if appropriate. It has also called for possible relief from repayment multipliers for smaller organizations. Whether the agencies will adopt those proposals, extend the pilot, or publish further guidance remains unknown.
Key Questions
What does the self-disclosure pilot allow providers to do?
It allows healthcare companies to voluntarily report certain civil False Claims Act violations and seek a coordinated resolution covering the False Claims Act and some HHS administrative authorities.
How long will the pilot run?
The announced pilot runs for six months and is scheduled to end on April 22, 2027. The source report does not say whether the agencies will extend it.
Does the pilot cover criminal Anti-Kickback Statute conduct?
No. The program is described as a civil False Claims Act initiative. Cutia said referral-related conduct covered by the criminal Anti-Kickback Statute is outside the pilot.
Could a provider still face repayment costs?
Yes. The program concerns resolution of disclosed conduct; it does not promise that repayment will be waived. The HCAOA has raised concerns that repayment multipliers could burden smaller providers and has called for possible waivers.
Is participation guaranteed to prevent exclusion or a Corporate Integrity Agreement?
No such guarantee is established in the source report. The HCAOA said the pilot could help well-meaning providers resolve civil liability without those outcomes, but the specific treatment of individual disclosures remains unclear.
Source: rss
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