司法部民事司与卫生部推出医疗反欺诈自我披露试点：企业自报《虚假申报法》违规可快速解决
美国司法部民事司与美国卫生与公众服务部（HHS）10 月 22 日宣布，联合推出医疗保健《虚假申报法》自我披露试点计划（Healthcare FCA SDPP）。司法部表示，该计划旨在为医疗保健企业提供一条通过自愿披露《虚假申报法》（FCA）潜在违规、快速解决过往不当行为的途径，并让政府把资源集中用于拒不改正的行为主体。
司法部民事司助理部长 Brett A. Shumate 说：「自愿自我披露是企业致力于合规与问责的有力标志。这一试点计划为愿意为过往行为承担责任的企业提供有利的解决框架，同时让司法部把资源集中在蓄意利用我国医疗保健系统牟利者身上。而对于不愿承担责任的企业，民事司将与举报人合作，揭露欺诈。」民事司副助理部长 Brenna Jenny 表示，该计划提供可预期、清晰的披露激励；企业发现不当行为、采取实质措施纠正问题并向政府赔付加罚款的，司法部将在确定适当解决方案时予以考虑。
按计划要求，参与企业必须说明所披露行为中涉及潜在违反联邦《虚假申报法》的全部相关细节，并提交足以完整反映违规性质、条款与运作的文件；企业还须说明已采取的补救措施，并按 1.25 至 1.6 倍的倍数作出财务赔付，具体倍数视披露及时性、不当行为的持续时间与范围、高层管理人员涉入程度、企业获利情况以及是否存在承继责任但已及时补救等因素而定。作为交换，企业将获得联邦《虚假申报法》及若干 HHS 行政权限下责任的协同民事免除。
司法部表示，企业可通过电子方式提交自我披露，FCA SDPP 受理提交的截止时间为 2027 年 4 月 22 日，逾期或不完整的提交将不予审查。司法部同时说明，该试点针对的是潜在违反民事法律的行为；涉及医疗保健潜在刑事行为的自我披露，应按司法部国家欺诈执法司与 HHS 监察长办公室的协调政策另行向该司提出。
DOJ Civil Division and HHS Launch Healthcare FCA Self-Disclosure Pilot Program
The Department of Justice Civil Division has partnered with the Department of Health and Human Services (HHS) to launch a Healthcare False Claims Act Self-Disclosure Pilot Program (FCA SDPP), the department announced on Oct. 22. The program is designed to give healthcare companies a way to quickly resolve past misconduct by self-disclosing potential violations of the federal False Claims Act (FCA) and to prioritize the government's resources toward recalcitrant actors, the department said.
"Voluntary self-disclosure is a powerful indicator of a company's commitment to compliance and accountability," said Assistant Attorney General Brett A. Shumate of the Justice Department's Civil Division. "This pilot program offers a favorable resolution framework to companies that want to take responsibility for past conduct while allowing the Department to concentrate resources on those who deliberately exploit our healthcare system. But for companies unwilling to take accountability, the Civil Division, in partnership with whistleblowers, will root out the fraud." Deputy Assistant Attorney General Brenna Jenny said that by providing predictable and clear incentives for self-disclosure, the pilot offers responsible companies an opportunity to move forward as stronger partners to federal healthcare programs, and that the department will take remediation and repayment into account in determining appropriate resolutions.
Participants must describe all relevant details of conduct that potentially violates the federal FCA and produce documents sufficient to fully reflect the nature, terms, and operation of the disclosed violations. Self-disclosing companies must describe the remedial actions they have taken and make a financial repayment with a 1.25-1.6 multiplier, which varies based on factors such as the timeliness of the disclosure, the duration and scope of the misconduct, the involvement of senior leadership, the financial benefit to the company, and whether the company has successor liability but promptly remediated. In exchange, companies will receive a coordinated civil release from liability under the federal False Claims Act and certain HHS administrative authorities.
Companies may submit self-disclosures electronically, and the FCA SDPP will accept submissions through April 22, 2027; late and incomplete submissions will not be reviewed. The department noted the pilot covers conduct that potentially violates civil laws; a company seeking to disclose potential criminal healthcare conduct must do so to the Justice Department's National Fraud Enforcement Division under the separate coordination policy with the HHS Office of Inspector General.
来源：GSM·美国（原文链接）
图片来源：图：美国卫生与公众服务部总部 Hubert H. Humphrey 大楼。照片：CC BY-SA 4.0，经 Wikimedia Commons。 / The Hubert H. Humphrey Building, headquarters of the U.S. Department of Health and Human Services. Photo: CC BY-SA 4.0, via Wikimedia Commons.
