Corporate Integrity Agreement Monitor

The OIG was established in 1976 by Congress (under President Ford) to implement effective measures against fraud and abuse. A number of laws and statutes, such as the False Claims Act of 1986, HIPAA and even the Affordable Care Act mandates, have expanded the OIG`s role in the fight against fraud and abuse in the health care field. In addition, the Department of Justice (DOJ) and other federal authorities have cooperated with strike forces and enforcement measures that have increased the number of CIA and civilian (CMP) fines. CIA services are used in place of exclusions and only when the OIG believes it is appropriate to resolve and implement continuous monitoring of health care compliance, as it applies to the agency or agency concerned. While a CIA will focus on the specific failure of the company`s compliance, all CLAs have common elements. A complete CIA typically lasts five years and requires the company to improve its compliance program through the development, implementation and monitoring of various areas of compliance and (2) to entrust annual audits and evaluations to an independent monitoring organization (IRO). Another factor to consider is whether the IRO already has experience in engaging the CIA or monitoring – in particular logistics in the management of these projects. An experienced IRO will be better able to provide a work plan with realistic schedules and specific budgets. This will help the company allocate its resources effectively. Cases of fraud and abuse in the health sector cost the industry billions of dollars each year, while health care providers face investigations that could cost them their reputation and income. As a result, health-related organizations accused of violating federal law may end up in the transaction agreement with the Department of Health and Human Services` Office of the Inspector General (OIG), prompting the company to comply with the strict conditions of an Integrity Corporate Agreement (CIA). As the goal of the HHS Office of Inspector General is to investigate fraud and abuse of the Medicare and Medicaid programs, it has the power to initiate settlement negotiations to prevent health care providers from being prosecuted for fraud and abuse. For health care providers involved in an investigation into health fraud, reaching an Enterprise Integrity Agreement (CIA) with the Office of Inspector General (OIG) is often a necessary condition for resolving the problem.

In accordance with the provisions of the OIG Corporate Integrity Agreement, health care providers must accept a number of detailed compliance obligations. In exchange, they will have the opportunity to avoid the exclusion of Medicare, Medicaid or other federal health programs, which is a financially devastating outcome for any health organization. Some CLAs ask an independent organization to verify and monitor compliance with CIA conditions. Most CLAs require harm checks to identify errors and their underlying causes. [1] The government authority can verify compliance through on-site visits. [1] If a company violates the agreement, the Agency can fine it and, if the problems cannot be resolved, the supplier may be excluded. [6] The first CIA was executed by the OIG for HHA in 1994.

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