DOJ's Healthcare Self-Disclosure Pilot Program: What a Civil False Claims Act Release Does Not Cover for Florida Providers and Their Employees

A Florida home health or DME owner who finds a kickback problem in last year's books now has a number to plan around. On October 22, 2026, the Justice Department's Civil Division and HHS announced a Healthcare False Claims Act Self-Disclosure Pilot Program: repayment at 1.25 to 1.6 times the government's damages, no Corporate Integrity Agreement, no CMS revocation, and a hard deadline of April 22, 2027. What the program does not offer is protection from a federal grand jury. The release is civil. It runs to the company. And the package DOJ requires is a documented account of the conduct, certified as complete by someone inside the business.

The pilot puts a price on civil repayment. It puts no limit on what a prosecutor can do with the same records.

Key Takeaways

• DOJ's healthcare self-disclosure pilot resolves civil liability under 31 U.S.C. § 3729 at 1.25 to 1.6 times damages for submissions made by April 22, 2027.
• The pilot is civil only; potential criminal conduct under 18 U.S.C. § 1347 or 42 U.S.C. § 1320a-7b goes to DOJ's National Fraud Enforcement Division.
• The protocol describes a release for the disclosing company and says nothing about the physicians, managers and billing staff whose conduct the exhibits document.
• Every submission requires a certification of truth and completeness, which places the signer inside 18 U.S.C. § 1001 if the account is shaded.
• South Florida providers should treat the civil-or-criminal classification as the first legal decision, made with counsel, before any document leaves the building.

What DOJ and HHS Announced on October 22

The pilot protocol is short and specific. A healthcare provider, supplier, manufacturer, payor or related entity that bills federal health care programs can disclose a potential False Claims Act violation that the government does not already know about. In exchange it receives a coordinated civil release from the Civil Division under the FCA and from HHS under three administrative authorities: Medicare enrollment revocation under 42 C.F.R. § 424.535 and permissive exclusion under 42 C.F.R. § 1001.901 and § 1001.951. HHS-OIG will not require a Corporate Integrity Agreement. CMS will not impose civil monetary penalties or seek revocation. The release carries no factual admissions.

The money term is the headline. Under 31 U.S.C. § 3729, FCA liability is three times the government's damages plus a per-claim penalty, and the statute's own disclosure discount only drops that to double damages, and only for a company that reports within 30 days of learning the facts. The pilot sets repayment at 1.25 to 1.6 times a base figure. For kickback conduct, DOJ will build that base from the remuneration paid and the revenue it generated rather than from the claims Medicare paid, which can be a fraction of the usual number.

What the Government Is Building

Read the pilot next to the policy the National Fraud Enforcement Division and HHS-OIG issued on October 15. That coordination policy and the updated HHS-OIG Self-Disclosure Protocol route criminal health care disclosures to the Justice Department, and DOJ says a company that discloses only to HHS-OIG generally has not made a voluntary self-disclosure to the Department. Footnote 1 of the new pilot closes the loop: a company seeking to disclose potential criminal conduct must take it to the Fraud Division. We covered the criminal side of that structure last week.

To qualify, the company must attach as exhibits the documents sufficient to fully reflect the conduct's nature, terms and operation. That is a complete charging file, organized by the company and cross-referenced to its own records.

The design favors the government on information. To qualify, the company must describe every relevant detail of the conduct, name the laws and time period, attach as exhibits the documents sufficient to fully reflect its nature, terms and operation, and give DOJ the financial data to compute repayment. That is a complete charging file for the conduct, organized by the company and cross-referenced to its own records. The release resolves the company's civil exposure. The protocol is silent on the individuals named in those exhibits, and DOJ's own language says the program "is not for illegitimate businesses that knowingly exploit" federal programs.

Exposure: The Conduct Behind a Civil Disclosure Is Often a Federal Crime

The line between an FCA problem and a criminal case is intent, and intent is the fact a company is least able to judge about its own people. The same billing pattern that supports a civil claim can support a charge under 18 U.S.C. § 1347, with up to 10 years per count, or a conspiracy count under 18 U.S.C. § 1349. Kickback conduct is the sharpest example. Under 42 U.S.C. § 1320a-7b(b), paying or receiving remuneration to induce federal program referrals is a felony carrying up to 10 years when done knowingly and willfully, and subsection (g) makes the resulting claims false for FCA purposes. A marketing arrangement disclosed as a civil matter is, on the same documents, an Anti-Kickback Statute case if a prosecutor reads the emails differently than the compliance committee did.

Then there is the certification. Each submission must include a statement from an authorized representative that the account is truthful and complete to the best of that person's knowledge.

Eligibility is a trap of its own. The pilot covers only violations "previously unknown to the federal government." A company cannot see a sealed complaint filed by a former employee. If one exists, the company is ineligible, falls back to ordinary cooperation credit under Justice Manual § 4-4.112, and has already handed over its exhibits.

A grand jury subpoena or a letter from the U.S. Attorney's Office can follow the submission. An agent at the door is the wrong moment to decide whether to talk.

Critical Mistakes Providers and Employees Make Early

The first mistake is letting the business office classify the conduct. Whether a problem is civil or criminal decides which door to use, and choosing the civil door for criminal conduct forfeits the criminal disclosure credit the October 15 policy offers.

The second is internal interviews without warnings. Employees questioned by company counsel are talking to the company's lawyer, not their own, and what they say can end up summarized in the disclosure.

The third is assuming silence means safety. An employee who learns the company is preparing a disclosure is, for practical purposes, under federal investigation. A grand jury subpoena or a letter from the U.S. Attorney's Office can follow the submission, and an agent at the door is the wrong moment to decide whether to talk.

The fourth is waiting for April. A disclosure assembled in the last two weeks is a partial disclosure, and partial submissions are not reviewed.

Strategic Defense Approach: Sequence the Doors, and Protect the People

For the company, the first step is a privileged assessment of intent exposure before anything is drafted. Where any criminal theory is plausible, the October 15 policy says to bring it to the Fraud Division first; a criminal disclosure under the Corporate Enforcement Policy does not need a duplicate filing in the civil mailbox. Where the conduct is plainly civil, such as a billing rule error with no inducement, the pilot's multiplier is a real reason to move now.

Whether a problem is civil or criminal decides which door to use. That classification is a legal decision, and it belongs with counsel before any document leaves the building.

For individuals, the work is different and starts sooner. A physician, office manager or billing lead whose conduct sits in the exhibits needs independent counsel before the company's interview, not after the submission. An experienced healthcare fraud attorney can evaluate whether a proffer session attorney should approach the AUSA early or whether the person is better served by silence. A white collar defense attorney representing the individual can also review the draft narrative for statements attributing intent that the facts do not support.

Why Timing Matters Before April 22, 2027

The pilot runs six months. The multiplier rewards timeliness, so the cost of waiting rises every month, and the eligibility test fails the moment the government learns of the conduct from someone else. Federal investigation defense is most effective before the charging decision is framed. In the Southern District of Florida, where healthcare fraud dockets run heavier than almost anywhere in the country, a disclosure filed this winter will be read by prosecutors who already know the local DME, lab and home health networks. The window to shape how they read it is now.

Common Questions

Weighing a Healthcare Self-Disclosure in Florida?

AMC Defense Law represents healthcare owners, physicians, managers and billing staff in federal investigations, Anti-Kickback Statute matters and pre-charge negotiations with the U.S. Attorney's Office, in South Florida and nationwide. If your company is considering a disclosure, or you have learned that your conduct may appear in one, the decisions made in the next several weeks matter. Contact AMC Defense Law for a confidential consultation with a federal criminal defense attorney.

Aaron M. Cohen, federal criminal defense attorney, AMC Defense Law

If you or your loved ones have been arrested or are under federal investigation, call Aaron M. Cohen, 24 hours a day to get help.

About the author. Aaron M. Cohen is the founder and principal attorney of AMC Defense Law, a criminal defense firm in Boca Raton, Florida, with more than 30 years of experience in state and federal courts. He is admitted to practice in Florida, New York, New Jersey, and the District of Columbia, and before the United States District Courts for the Southern and Middle Districts of Florida, the Southern, Eastern, and Western Districts of New York, the District of New Jersey, and the Northern District of Texas. He appears pro hac vice in other federal districts nationwide. The firm represents clients in federal investigations and prosecutions involving healthcare fraud, Anti-Kickback Statute matters, DME and telemedicine fraud, peptide and compounded-drug enforcement, controlled-substance and drug conspiracy cases, financial crimes, and complex federal litigation, in Florida and nationwide.

This article is for informational purposes only and does not constitute legal advice. Reading this article does not create an attorney-client relationship with AMC Defense Law or Aaron M. Cohen. Every federal case is fact-specific. Past results do not guarantee future outcomes.