Health Care Fraud Self-Disclosure Now Runs Through DOJ: What Florida Providers and Their Employees Need to Know

If your practice, lab, pharmacy or DME company found a billing or referral problem and the plan was to quietly report it to HHS-OIG and pay it back, that plan changed on October 15, 2026. The Justice Department's National Fraud Enforcement Division and HHS-OIG issued a joint policy that sends every potentially criminal health care disclosure to one place: the Fraud Division's Health Care Fraud Section. A disclosure made only to HHS-OIG generally no longer counts as voluntary self-disclosure for criminal purposes. For the company, that is a procedural change. For the physicians, managers and billing staff inside the company, it is a change in who learns about them first.

Since October 15, 2026, a potentially criminal health care disclosure has one door: the Fraud Division's Health Care Fraud Section.

Key Takeaways

• Since October 15, 2026, companies disclosing potential criminal health care fraud must go to DOJ's Health Care Fraud Section to earn self-disclosure credit.
• A disclosure made only through the HHS-OIG Self-Disclosure Protocol generally cannot support a DOJ declination under the Corporate Enforcement Policy.
• The conduct at issue is usually charged under 18 U.S.C. § 1347, 18 U.S.C. § 1349 and the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b).
• A company that discloses to DOJ is expected to identify culpable individuals, which puts employees and physicians at the center of the case.
• South Florida providers should assume a disclosure lands with the Miami-based strike force prosecutors who already handle Southern District of Florida health care fraud.

What Changed on October 15

The Fraud Division and HHS-OIG announced the change in a DOJ press release and a matching HHS-OIG enforcement notice. Under the joint policy, a company that self-discloses potentially criminal conduct affecting a federal health care program makes one disclosure, to the Health Care Fraud Section, and receives the benefits of both DOJ's Corporate Enforcement Policy and the HHS-OIG Self-Disclosure Protocol. The Fraud Division sends HHS-OIG a copy. No separate portal filing is needed.

HHS-OIG rewrote its own Self-Disclosure Protocol the same day. The updated protocol says the SDP "is not available for disclosure of Federal crimes" and that any criminal conduct disclosed through it "will be referred to DOJ for resolution." The SDP still handles civil monetary penalty matters, with OIG's usual minimum multiplier of 1.5 times single damages and a presumption against a corporate integrity agreement.

It may still earn cooperation or remediation credit. That is a lesser benefit, and in a criminal case the difference between a declination and cooperation credit can be the difference between no charge and a plea.

What the Government Is Building

Read this policy next to Directive 26-12, which Assistant Attorney General Colin M. McDonald issued on October 1. The directive names health care fraud as a top corporate priority and lists charging factors that get "great weight," including management involvement, concealment, schemes lasting three years or more, conduct reaching three or more federal districts, and losses of $25 million or more. The October 15 policy is the intake side of the same machine: it routes company-generated evidence directly to criminal prosecutors.

The prosecutors receiving a Florida disclosure are the same people who build the Southern District of Florida and Middle District of Florida health care fraud docket.

The Health Care Fraud Section runs nine strike forces and, by DOJ's count, has charged more than 6,200 defendants since 2007. The Health Care Fraud Unit opened its first strike force in Miami in 2007. When a Florida company discloses, the prosecutors receiving it are the same people who build the Southern District of Florida and Middle District of Florida health care fraud docket. They will read a disclosure the way they read a cooperator's proffer: as a roadmap to people.

The policy's own text says it. Early disclosure matters, according to the document, so that action can be taken "before evidence against culpable individuals becomes stale." A company earns its credit by handing over facts, and the most valuable facts are names.

Exposure and Charges for the People Inside the Company

The conduct that drives most disclosures falls under a short list of statutes. Health care fraud under 18 U.S.C. § 1347 carries up to 10 years per count, more if a patient is seriously injured. Conspiracy under 18 U.S.C. § 1349 carries the same maximum as the object offense. Kickbacks under the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), carry up to 10 years per violation. A conviction for program-related crimes triggers mandatory exclusion under 42 U.S.C. § 1320a-7(a), which the SDP does not resolve.

At sentencing, loss drives the number. Under the fraud guideline, loss amount, government-payor enhancements and role adjustments stack quickly, and a case built on years of claims data can produce a guideline range far above what the individual personally received. A billing manager who never touched the money can still be charged with the full conspiracy.

That pressure pushes companies toward disclosure fast, often before anyone has asked the individuals whether they need their own federal criminal defense attorney. The same dynamic played out when a Florida lab self-reported its kickback problem.

Critical Mistakes People Make Early

The first mistake is assuming the company's lawyers represent you. They represent the company. Under this policy, the company's interest is to disclose fully, cooperate and identify who did what. Your interest may be the opposite.

Those interview memos become the government's first draft of your role.

The second is sitting for an internal investigation interview without understanding that your words may be summarized and handed to the Health Care Fraud Section. Those interview memos become the government's first draft of your role. A false or incomplete answer to agents later can add a charge under 18 U.S.C. § 1001.

The third is treating the absence of a subpoena as safety. When a company discloses, the government often has your emails, your claims history and a witness account before it ever contacts you. The first sign may be FBI agents at your door, a federal grand jury subpoena, or a letter from the U.S. Attorney's Office stating that you are a target.

The fourth is waiting for an indictment to hire counsel. By then, the narrative is set.

Strategic Defense Approach

Federal investigation defense for an individual in a disclosure case starts with one question: has the company already gone to DOJ, and if not, when will it? The answer shapes everything else. If the disclosure has not happened, counsel can sometimes position the individual before the company's narrative hardens. If it has, the task is to learn what was disclosed and get in front of the Health Care Fraud Section with context the company had no reason to provide.

Not every disclosed problem is a crime. Many involve coding disputes, documentation gaps or arrangements that fit, or nearly fit, a safe harbor. Knowledge and intent are elements under § 1347 and the Anti-Kickback Statute, and a white collar defense attorney who can show the government a good-faith account early can change a charging decision. Pre-charge negotiation with an AUSA is where that happens.

Why Timing Matters Right Now

The policy applies to disclosures made on or after October 15, 2026. Companies that were preparing HHS-OIG submissions now have to decide whether to redirect them to DOJ, and many will. That means a wave of disclosures will reach criminal prosecutors over the coming months, and the individuals named in them may not know it yet.

After the disclosure is made, you are reacting to a file someone else wrote.

If you work in billing, compliance, marketing or management at a Florida health care company that is conducting an internal review, the window to protect yourself is the period before the disclosure is made. After that, you are reacting to a file someone else wrote.

Common Questions

Facing a Health Care Fraud Investigation in Florida?

If your company is reviewing its billing or referral arrangements, or you have received a target letter, a grand jury subpoena or a visit from agents, the decisions made now carry forward into everything that follows. AMC Defense Law represents individuals in federal health care fraud investigations from Boca Raton, throughout Florida, and in federal districts nationwide. Contact the firm for a confidential consultation.

Aaron M. Cohen, AMC Defense Law, Boca Raton.

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.