DOJ and HHS Open a Six-Month Window for Health Care Companies to Self-Disclose False Claims Act Problems

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On October 22, 2026, the Justice Department’s Civil Division and the Department of Health and Human Services announced a six-month Healthcare False Claims Act Self-Disclosure Pilot Program (FCA SDPP). The program gives health care companies a priced, time-limited path to resolve potential civil False Claims Act (FCA) liability by coming forward first. The window closes at 11:59 PM on April 22, 2027, according to the DOJ–HHS program document.

It was not the only health care fraud news from DOJ that day. On the same date, the Justice Department announced a Los Angeles health care fraud takedown charging 15 defendants, which Bajaj Law covered here. Taken together, the two announcements show the government offering a civil route to companies that come forward and pursuing criminal charges against the people it says are committing fraud.

This post is analysis of public DOJ and HHS materials. It is not legal advice and does not predict how any disclosure, investigation, or case will turn out.

What DOJ and HHS announced

The program is a joint effort of the DOJ Civil Division and three parts of HHS: the Office of the General Counsel, the Office of Inspector General (HHS-OIG), and the Centers for Medicare & Medicaid Services (CMS). According to the program document, it offers “a clear and predictable pathway” to a coordinated resolution of civil liability under the False Claims Act, 31 U.S.C. § 3729 et seq., and three HHS administrative authorities:

The program document says it “supports legitimate American healthcare businesses” and “is not for illegitimate businesses that knowingly exploit” federal programs “through various fraudulent schemes.”

Civil Division Assistant Attorney General Brett A. Shumate said in the DOJ release that the program lets the Department “concentrate resources on those who deliberately exploit our healthcare system,” and added: “for companies unwilling to take accountability, the Civil Division, in partnership with whistleblowers, will root out the fraud.”

Who is eligible

The program document covers health care providers, suppliers, manufacturers, payors, and related entities that “furnish, arrange for, manufacture, distribute, insure, administer, or bill for items or services” paid for, directly or indirectly, by HHS federal health care programs.

The key limit is that the disclosure must involve a potential FCA violation “previously unknown to the federal government.” If the government already knew about the conduct, the company may still get credit under Justice Manual § 4-4.112, DOJ’s existing guidance on disclosure, cooperation, and remediation in FCA matters. It will not qualify for a pilot-program resolution.

What a disclosure must include

Under the program document, a submission must be complete when it is filed. It must:

  • describe all relevant details of the conduct that, in the company’s reasonable assessment, potentially violates the FCA, including the specific laws, regulations, or other binding requirements involved and the time period;
  • attach as exhibits all documents sufficient to fully reflect the nature, terms, and operation of the conduct, cross-referenced in the written description;
  • describe the remedial and corrective steps already taken to stop the conduct and prevent it from happening again;
  • provide financial information sufficient for the Civil Division to calculate the “Base Self-Disclosure Repayment”;
  • include a certification from an authorized representative that, to the best of that person’s knowledge, the submission is truthful and complete; and
  • name a point of contact with a phone number and email address.

Submissions go to FCA-SDPP@usdoj.gov. Both the DOJ and HHS releases say late or incomplete submissions will not be reviewed.

What the government offers in return

A priced repayment: 1.25 to 1.6 times the base amount

The company repays 1.25 to 1.6 times the Base Self-Disclosure Repayment. According to the program document, where a company falls in that range depends on factors such as:

  • how timely the disclosure was;
  • how long the misconduct lasted and how broad it was;
  • whether senior leadership was involved;
  • how much the company benefited financially; and
  • whether the company has successor liability for the conduct but promptly fixed it.

For comparison, a defendant found liable under the FCA owes a civil penalty per violation plus “3 times the amount of damages which the Government sustains,” under 31 U.S.C. § 3729(a)(1). The statute already lets a court lower damages to “not less than 2 times” when a person reports all known information within 30 days, fully cooperates, and no action has started and the person did not know of an investigation, under § 3729(a)(2). On its face, the pilot’s published multiplier sits below both of those levels. It is applied to the program’s “Base Self-Disclosure Repayment,” though, and it is available only to companies that meet the program’s conditions.

One coordinated civil release

According to the program document and the HHS release:

  • the Civil Division releases the disclosed potential FCA violations;
  • HHS-OIG will not require a Corporate Integrity Agreement, and the HHS release says OIG will not impose an exclusion as part of the resolution;
  • CMS will not revoke the provider’s or supplier’s enrollment and billing privileges, and the HHS release says neither CMS nor OIG will impose civil monetary penalties; and
  • the company does not need to make separate disclosures of the same conduct through the HHS-OIG Health Care Fraud Self-Disclosure Protocol or the CMS Self-Referral Disclosure Protocol.

The program document also says the release comes “with no factual admissions.”

The government’s two examples

The program document gives two examples:

  1. A hospital and the 14-day rule. A hospital finds it delayed submitting physician lab orders to get around Medicare’s 14-day rule (42 C.F.R. § 414.510). It reviews a sample of charts, extrapolates the error rate across its claims, and gives the government the results and its methods.
  2. An acquirer that finds kickbacks after closing. A company buys a health care business and later finds legacy conduct that may create FCA liability through the Anti-Kickback Statute. For this pilot only, the government says it will not base the repayment on claims-paid amounts. It will instead consider the amount of the remuneration, the revenue from the conduct, and whether aggravating factors such as patient harm are absent.

Civil only: criminal conduct goes to a different office

The pilot covers civil liability only. Footnote 1 of the DOJ release and the program document says a company seeking to self-disclose potential criminal conduct related to health care “must disclose that conduct” to DOJ’s National Fraud Enforcement Division. That disclosure follows the Fraud Division’s coordination policy with HHS-OIG on voluntary self-disclosure in health care fraud matters. A company that has already self-disclosed criminal matters to the Fraud Division does not need to file a duplicate submission. If it also wants a civil FCA release, DOJ will ask for more information only as needed.

That footnote matters for any health care business deciding what to do. DOJ’s own manual says “[c]riminal and civil fraud investigations by the FBI and other investigative agencies should be carried out concurrently” and that criminal, civil, regulatory, and administrative proceedings “should be coordinated to the fullest extent possible” (JM § 4-4.110). The Fraud Division is also prosecuting the Chicago case described at the end of this post. A civil-only release is not a promise about criminal exposure.

Why there is a race to disclose

The program accepts only conduct the government does not already know about, and the FCA lets private whistleblowers (“relators”) file qui tam suits on the government’s behalf. Under 31 U.S.C. § 3730(b)(2), a relator files the complaint under seal and serves it, along with “substantially all material evidence,” on the government. The company may not learn about it for months.

As Troutman Pepper Locke’s October 28 analysis explains, if a whistleblower reaches the government first, the conduct is no longer “unknown” and the company can lose access to the pilot. Timeliness also affects where a company falls in the 1.25–1.6 range. A billing manager, coder, or former executive who has already raised concerns inside the company is therefore part of the timing analysis.

What a disclosure involves

DOJ calls the pilot a “favorable resolution framework,” but filing has consequences:

  • The submission is a certified written account. Even with a release “with no factual admissions,” the company is giving the government a detailed narrative, the supporting documents, and a damages calculation, signed under a truthfulness certification. Under 18 U.S.C. § 1001, materially false statements to the federal government are a separate federal crime.
  • The release has limits. It covers the disclosed potential FCA violations and the listed HHS authorities. Troutman’s analysis notes that self-disclosure “does not necessarily foreclose liability under other civil or criminal statutes.”
  • Individuals are not the company. The program speaks to the “disclosing company.” Owners, physicians, executives, and billing staff should not assume a corporate civil release covers their own exposure.
  • The civil-or-criminal choice comes first. Because criminal conduct goes to the Fraud Division, the company needs to know early whether the facts suggest knowing and willful conduct, such as kickbacks or billing for services never provided, or a compliance failure that can be fixed.

What San Diego health care businesses should consider now

Clinics, labs, durable medical equipment (DME) suppliers, hospice and home health agencies, pharmacies, physician groups, and private-equity or strategic buyers of health care businesses in San Diego and Southern California fall within the program’s eligibility language. Practical steps include:

  1. Start a privileged internal review led by counsel, before any decision to disclose and before outside conversations about the issue.
  2. Assess criminal exposure first. Counsel should decide whether the facts call for the civil SDPP, the Fraud Division’s criminal disclosure channel, both together, or neither. Positions taken with the Civil Division and the Fraud Division should be consistent.
  3. Measure the problem, using claims sampling, extrapolation methods, and remuneration and revenue analysis, so the submission is complete on day one.
  4. Fix the problem and document the fix before filing. The program requires a description of corrective steps already taken.
  5. Review acquisition diligence and post-closing integration findings. The government’s own example involves a buyer that found kickbacks after closing, and successor liability with prompt remediation is a listed mitigating factor.
  6. Decide carefully who signs the certification, and verify the submission line by line.
  7. Work backward from April 22, 2027. A complete submission with exhibits and a damages calculation takes time, and timeliness affects the multiplier.

If agents, a civil investigative demand, a subpoena, or a target letter has already arrived, the conduct may no longer be “unknown.” The question then shifts to cooperation credit under JM § 4-4.112 and defense strategy. Bajaj Law’s earlier post on DOJ’s National Fraud Detection Center explains why cross-agency data sharing can shorten that timeline.

Also this week: $227 million COVID test kit plea in Chicago

On October 30, 2026, DOJ announced that Syed Murtuza Kablazada, 36, of Des Plaines, Illinois, pleaded guilty to two counts of health care fraud. According to the release, he and co-schemers acquired three Chicago-area laboratories, paid about $11 million to a purported Pakistan-based telemarketing company for Medicare beneficiaries’ personal information, and caused $227 million in claims for over-the-counter COVID-19 test kits that beneficiaries never requested or received. Medicare paid about $136 million. He agreed to forfeit more than $46 million and faces a maximum of 20 years in prison. The Fraud Division’s Health Care Fraud Section is prosecuting the case, and the FBI and HHS-OIG investigated. A guilty plea is an admission by that defendant only, and the court will determine any sentence.

The case shows the other side of the government’s message: the pilot is for “legitimate” businesses, while schemes like the one Kablazada admitted to are handled as criminal prosecutions. For a related prosecution, see Bajaj Law’s post on a COVID test billing fraud indictment.

About Bajaj Law

Attorney Vikas Bajaj is licensed in California and Texas and practices in federal courts around the nation when admitted, handling federal criminal and white-collar matters well beyond any single district. His federal courtroom experience includes matters in the Western District of Texas, the Eastern District of Michigan, the Western District of Washington, and the District of New Jersey. For San Diego and Southern California health care fraud and federal white-collar concerns, see Bajaj Law’s pages on health care fraud defense, white-collar defense, and federal crimes defense.

Disclaimer

Attorney Advertising. This post is for general informational purposes only. It is not legal advice and does not create an attorney-client relationship. Whether to self-disclose, and through which channel, depends on specific facts and controlling law. Consult qualified counsel before making any disclosure to the government or responding to any investigation.

Sources

  1. U.S. Department of Justice, Office of Public Affairs: Justice Department’s Civil Division and the Department of Health & Human Services Announce Anti-Fraud Healthcare Self-Disclosure Pilot Program (Oct. 22, 2026)
  2. DOJ and HHS: Healthcare Self-Disclosure Pilot Program (FCA SDPP protocol) (PDF)
  3. U.S. Department of Health and Human Services: Department of Health and Human Services and the Justice Department’s Civil Division Announce Anti-Fraud Healthcare Self-Disclosure Pilot Program (Oct. 22, 2026)
  4. Troutman Pepper Locke: DOJ Civil Division and HHS Launch Healthcare False Claims Act Self-Disclosure Pilot Program (Oct. 28, 2026)
  5. U.S. Department of Justice, Justice Manual: JM 4-4.110 and 4-4.112
  6. 31 U.S.C. § 3729 (False Claims Act liability; reduced damages) and 31 U.S.C. § 3730 (qui tam actions); FCA at 31 U.S.C. §§ 3729–3733
  7. 42 C.F.R. § 424.535, § 1001.901, § 1001.951, § 414.510
  8. 18 U.S.C. § 1001 (false statements)
  9. U.S. Attorney’s Office, Central District of California: L.A. Health Care Fraud Takedown Results in 15 Defendants Charged (Oct. 22, 2026)
  10. U.S. Department of Justice, Office of Public Affairs: Indian National Pleads Guilty to $227M Medicare Fraud (Oct. 30, 2026)