DOJ's Civil Self-Disclosure Pilot: Repay 1.25x to 1.6x, No CIA. Closes April 22

The criminal-side policy we covered October 26 left False Claims Act exposure open. DOJ's Civil Division and HHS have answered with a six-month pilot that trades a capped repayment for a release, no admissions and no Corporate Integrity Agreement, if the government doesn't already know.

On October 22, 2026, the Justice Department's Civil Division and HHS (its general counsel, OIG and CMS) launched a six-month Healthcare False Claims Act Self-Disclosure Pilot Program. Disclosures go to FCA-SDPP@usdoj.gov by 11:59 p.m. on April 22, 2027. “Late or partial submissions will not be accepted or reviewed.” That's just under six months away.

It fills the gap in our October 26 piece on the October 15 policy sending possibly criminal conduct to DOJ first. That policy said nothing about the Civil Division, so a criminal disclosure didn't settle False Claims Act exposure. The pilot is the civil door.

The turn: this is a deal with a price and a deadline

The pilot fixes the cost of a civil resolution at “1.25–1.6 times the amount of the Base Self-Disclosure Repayment.” Where in that range a company lands depends on “the timeliness of the self-disclosure, the duration and scope of the misconduct, the involvement of the company's senior leadership, the financial benefit to the disclosing company,” and successor liability with prompt remediation. For comparison, OIG's own protocol starts at 1.5 times single damages. The bottom of this range is lower, and the top isn't far above it. What the pilot adds is what comes with the payment.

What the protocol says

  • Who: providers, suppliers, payors and related entities paid “directly or indirectly, by HHS Federal health care programs.”
  • The condition: the conduct must be “previously unknown to the federal government.” If the government already knows, the company can get ordinary cooperation credit under Justice Manual 4-4.112, but not a pilot resolution.
  • What you get: a coordinated civil release “with no factual admissions”, including a DOJ FCA release. It also releases the HHS permissive-exclusion authorities at 42 CFR 1001.901 and 1001.951, and Medicare enrollment revocation at 424.535. “HHS OIG shall not require a Corporate Integrity Agreement,” and “CMS shall not impose civil monetary penalties or seek revocation.” No separate filing under the OIG protocol is needed.
  • What you must send: all relevant conduct with the specific rules violated and the time period, exhibits, remedial steps taken, financial information for the base repayment, a certification by an authorized representative, and a contact.
  • How the base is built: the protocol's first example is a sample chart review with an error rate extrapolated across the claims. Its second is an acquirer that finds kickback exposure in a company it bought; there, the base is computed from the remuneration and revenue, not claims paid.

The limits

Everything released is federal. The protocol doesn't mention state Medicaid agencies, state false claims acts or Medicaid Fraud Control Units. For a Medicaid-heavy ABA practice, the state share of an overpayment and a state's own enrollment action are outside what this document settles. Criminal conduct is excluded and still goes to DOJ's National Fraud Enforcement Division. The pilot runs six months, and nothing in it says it will be extended.

What you must know or do

  • Owners and compliance leads: pull any internal audit or payer review from the past few years that found a pattern rather than a one-off: sessions billed without notes, supervision billed but not delivered, services by someone not enrolled. List each one with its dates.
  • For each item on that list: check your files for any government letter, records request, subpoena or MFCU contact on the same conduct. Any of those likely means the government already knows, and the pilot isn't available.
  • Counsel's call, on your calendar: a sample review and extrapolation takes weeks. If anything on the list could be a False Claims Act matter, get it to a healthcare attorney before the end of the year, not in April.
  • Update the triage from our October 26 piece: billing error to the payer refund process, CMP-only exposure to OIG's protocol, possible FCA liability to this pilot by April 22, possibly criminal conduct to counsel and DOJ's Fraud Division.
  • If you've bought a practice: run the same check on its legacy billing. Successor liability with prompt remediation is one of the factors the pilot weighs.