By Sean Orr, M.D. | November 2, 2026 | Florida Doctor Magazine
On October 22, the Justice Department’s Civil Division and the Department of Health and Human Services opened a six-month window for health care organizations to report their own potential False Claims Act violations and resolve them by repaying 1.25 to 1.6 times the amount owed, instead of the treble damages and per-claim penalties the statute allows. Submissions close at 11:59 p.m. on April 22, 2027. For a Florida practice that bills Medicare, Medicaid or TRICARE, the pilot changes the cost of a billing problem found in an internal review. It does not release claims under Florida’s own False Claims Act, so Medicaid exposure to the state has to be handled separately. If your practice has an unresolved billing question, review it with your health care attorney now.
What the Pilot Offers
The program is formally called the Healthcare False Claims Act Self-Disclosure Pilot Program. According to the Justice Department’s announcement and the published protocol, it is open to providers, suppliers, payors and related entities paid directly or indirectly by federal health care programs. The conduct must be previously unknown to the federal government. A company must describe the conduct in full, produce the documents that show it, explain how it stopped it and certify that the submission is complete.
In return, the government offers a coordinated civil release with no admission of facts. The release covers the federal False Claims Act and two HHS administrative remedies, Medicare enrollment revocation and permissive exclusion. Under the protocol, the HHS Office of Inspector General will not require a Corporate Integrity Agreement and CMS will not impose civil monetary penalties. Where a settlement falls in the 1.25 to 1.6 range depends on how early the company came forward, how long the conduct ran, whether senior leaders were involved and how much the company gained. For kickback cases, the starting figure is the remuneration and the revenue it produced, not the full value of the claims paid.
The OIG’s existing Health Care Fraud Self-Disclosure Protocol generally requires a minimum multiplier of 1.5 and a minimum settlement of $20,000, or $100,000 for kickback matters. Potential criminal conduct is outside the pilot entirely and goes to the Justice Department’s National Fraud Enforcement Division under a separate policy.
Why It Matters for Florida Physicians
The pilot arrives during the most aggressive period of False Claims Act enforcement on record. The Justice Department reported more than $6.8 billion in recoveries for fiscal year 2025, more than $5.7 billion of it from health care, and 1,297 new whistleblower suits, according to a Morgan Lewis summary of the figures. Florida has been central to it. We covered the $541 million Villages Health upcoding settlement in September and the CMS plan to quadruple Medicare payment suspensions in October.
The federal overpayment rule already requires action. Since January 1, 2025, a Medicare overpayment counts as identified when the provider knowingly receives or retains it, using the False Claims Act’s definition of knowledge, which includes reckless disregard. The provider has 60 days to report and return it, suspended for up to 180 days during a timely, good-faith investigation of related claims, as Bass, Berry and Sims explains. The pilot does not replace that rule. It gives a practice facing potential fraud liability, rather than a simple coding error, a more predictable resolution.
The Florida-specific gap is state law. The pilot’s release covers federal liability only, and Sidley’s analysis notes that it does not reach state claims, other agencies or whistleblower suits. Florida Medicaid is funded jointly by the state and federal governments, and the Florida False Claims Act, section 68.082, makes a violator liable for treble the state’s damages plus civil penalties. The same section allows a court to reduce that to no less than double damages when the person gave the Florida Department of Legal Affairs all known information about the violation within 30 days of first learning of it. That 30-day clock is much shorter than the federal timelines, and a practice with Medicaid claims involved should plan around it from the first day of a review.
The Case for Caution
There is a reasonable argument against moving quickly. A disclosure creates a detailed record, and the release does not cover state claims or any whistleblower suit already under seal. If a former employee has already filed a case, the conduct may not qualify as previously unknown. For a small practice whose problem is an honest coding error with no knowing conduct, a refund through the Medicare Administrative Contractor under the 60-day rule may be simpler and cheaper than any formal disclosure. Some will argue that lower multipliers weaken deterrence; the Justice Department’s view is that predictable terms bring more problems to light and free its attorneys for the cases that deserve full penalties. Both positions have merit, and the right choice depends on the facts in each practice.
What Florida Physicians Should Do Now
- Separate honest mistakes from potential liability. A coding error with no knowing conduct is an overpayment to return within 60 days. Conduct that someone in the practice knew about, or recklessly ignored, is a potential False Claims Act matter, and that is where the pilot applies.
- Review the areas that draw enforcement. Ask your health care attorney to direct a review, so that the work is protected by privilege, of evaluation and management level distribution, modifier 25, incident-to billing, telehealth claims, Medicare Advantage diagnosis coding and any marketing or referral arrangement. Our report on the Florida Patient Brokering Act and marketing percentage deals covers the referral side.
- Write down the clocks. Record the date the practice first learned of a possible problem. That date starts the federal 60-day period, the possible 180-day investigation suspension and the 30-day Florida reporting window. The pilot itself closes on April 22, 2027.
- Choose the route with counsel. The options include a refund through your Medicare Administrative Contractor, the OIG Self-Disclosure Protocol, the CMS Self-Referral Disclosure Protocol for Stark issues, and the new pilot. None of this constitutes legal advice, so make that decision with a Florida health care attorney who has handled self-disclosures before.
- Address Florida Medicaid separately. If Medicaid claims are involved, ask counsel how and when to approach the Florida Attorney General’s office, because the federal release will not resolve the state’s claim.
- Fix the process and document the fix. The pilot requires a description of remedial steps. Train staff, change templates and audit again in 90 days. If you are in a small practice, ask your county medical society whether a shared compliance auditor is available.
The Bigger Picture
Most physicians I know want to bill correctly under rules that change every year. A program that rewards a practice for finding and reporting its own errors treats physicians as partners in program integrity rather than only as targets of it, and that is the right direction. It would be better still if Florida offered a matching path for state claims, and the Florida Medical Association is well placed to ask the Legislature for one before the 2027 session convenes in March. For more of our coverage on Medicare billing and payer changes, see our Medicare and payer guide for Florida physicians.
Frequently Asked Questions
Can a Florida physician practice use the DOJ False Claims Act self-disclosure pilot?
The protocol is open to providers, suppliers and related entities paid directly or indirectly by federal health care programs, which on its face includes a physician practice that bills Medicare, Medicaid or TRICARE. The conduct must be previously unknown to the federal government. Whether a particular practice qualifies is a question for its health care attorney.
What is the deadline for the self-disclosure pilot?
Submissions must arrive by 11:59 p.m. on April 22, 2027. The Justice Department says late or incomplete submissions will not be reviewed.
Does the pilot resolve Florida Medicaid claims?
No. The release covers the federal False Claims Act and certain HHS administrative remedies only. Claims under the Florida False Claims Act, section 68.082, have to be resolved with the state, and that statute reduces treble damages to no less than double only when information is given to the Department of Legal Affairs within 30 days.
How is this different from returning a Medicare overpayment?
The 60-day overpayment rule requires every provider to report and return money it knowingly received in error. The pilot is for conduct that may create False Claims Act liability and offers a release from that liability at 1.25 to 1.6 times the amount owed.
Will a self-disclosure lead to exclusion or a Corporate Integrity Agreement?
Under the pilot protocol, HHS OIG will not require a Corporate Integrity Agreement, and the release covers Medicare enrollment revocation and permissive exclusion. Criminal conduct is outside the pilot and goes to the Justice Department’s National Fraud Enforcement Division.
This article is general information for physicians and is not legal advice. Consult a Florida health law attorney about your practice’s specific obligations.
This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. Illustration created with AI image tools.
References
- U.S. Department of Justice, “Justice Department’s Civil Division and the Department of Health & Human Services Announce Anti-Fraud Healthcare Self-Disclosure Pilot Program” (October 22, 2026). justice.gov
- U.S. Department of Justice, Healthcare False Claims Act Self-Disclosure Pilot Program protocol (October 2026). justice.gov
- Sidley Austin, “DOJ and HHS Launch Healthcare FCA Self-Disclosure Pilot Program With Fixed Repayment Multiplier” (October 22, 2026). fcablog.sidley.com
- Holland & Knight, “DOJ and HHS Launch New Healthcare False Claims Act Self-Disclosure Pilot Program” (October 2026). hklaw.com
- HHS Office of Inspector General, Health Care Fraud Self-Disclosure Protocol. oig.hhs.gov
- Morgan Lewis, “DOJ Announces Highest-Ever Annual False Claims Act Recoveries: Over $6.8 Billion in Fiscal Year 2025” (January 20, 2026). morganlewis.com
- Bass, Berry & Sims, “A New Year, A New Overpayment Rule: CMS Revises the 60-Day Rule” (December 30, 2024). bassberry.com
- Florida Statutes § 68.082, False claims against the state; definitions; liability. flsenate.gov