The False Claims Act Self-Disclosure Pilot: What Home Care Agencies Should Know

Federal regulators just gave healthcare providers a clearer way to fix billing mistakes they find on their own. On Oct. 22, the U.S. Department of Health and Human Services (HHS) and the Justice Department's Civil Division launched a six-month Healthcare False Claims Act Self-Disclosure Pilot Program. For home health and home care agencies that run internal audits, False Claims Act self-disclosure now comes with a defined process, a predictable repayment range and a firm deadline: submissions are accepted through April 22, 2027.

How the False Claims Act self-disclosure pilot works

The pilot is open to providers, suppliers and other organizations that bill HHS-funded programs such as Medicare and Medicaid. The conduct being disclosed has to be a potential civil False Claims Act violation that the government does not already know about. Companies describe what happened and the time period, attach the supporting documents, explain the corrective steps they have taken and repay the base amount times a multiplier between 1.25 and 1.6. The exact multiplier depends on factors like how quickly the issue was reported, how long it lasted, whether senior leaders were involved and whether the company inherited the problem through an acquisition. In return, participants receive a coordinated civil release under the False Claims Act and certain HHS authorities, including Medicare enrollment revocation and permissive exclusion.

What it means for home-based care

As Home Health Care News reported, most problems agency audits surface are not fraud. They are documentation gaps with billing consequences, such as a certification signed a couple of days late or a face-to-face note that misses a required element. Until now, many operators fixed the issue, refunded what they believed they owed and hoped that was the end of it. The pilot puts a number and a timeline on that decision. It is also limited in scope. It covers civil conduct only, so potential criminal issues, including kickback concerns, follow a separate disclosure path through the Justice Department's National Fraud Enforcement Division. The Home Care Association of America supports the pilot but has raised concerns that the multiplier could weigh heavily on small, low-margin agencies and asked regulators to consider waivers.

Getting ready before you need it

The pilot rewards agencies that can find problems early and document them well. That starts with routine internal audits, clear ownership between clinical and billing teams, and records that show what was scheduled, what was actually delivered and what changed along the way. Planned-versus-completed visit visibility is one piece of that picture, and it is the kind of view CareSync® was built to make easier to see. This is not legal advice, so any agency weighing a disclosure should talk with compliance counsel before acting.

Programs like this are a reminder of how much home health professionals learn from comparing notes with each other. Something exclusive is being built for people in this field, a small invite-only circle where those conversations can happen, and we hope it will be genuinely useful. More on that soon. In the meantime, the pilot protocol from HHS and the Justice Department is worth a careful read for anyone who owns compliance at an agency.

Sources: HHS press release, U.S. Department of Justice announcement and protocol, Home Health Care News.