Corporate Integrity Agreements
A Corporate Integrity Agreements (CIA) is a document that outlines the obligations a health care provider agrees to as part of a civil settlement.
The provider agrees to the CIA obligations in exchange for the Office of Inspector General (OIG) agreement that it won’t seek to exclude the provider from participation in Medicare, Medicaid or other Federal health care programs. The OIG is part of the Department of Health & Human Services.
CIAs are put in place at the discretion of the OIG, and are designed to get a provider back on the path of compliance.
As shown in the figure below, the number of CIAs has increased steadily. In a 5 year period (2009 to 2014), the number of CIAs has increased more than 10 times.
Why Does a CIA Happen?
In a typical scenario, a provider has been audited and found to be afoul of various OIG regulations. The provider has then been forced to make a repayment of faulty claims and also possibly suffer a Civil Money Penalty (CMP). CMPs can be a fine of up to $10,000 per claim.
What Relief Does a CIA Offer?
In many cases, adopting an integrity agreement has been the only way to stay in business. The alternative is a suspension of the right to do business with the Federal Government.
If this happens, the provider is cut off of Medicare and also Medicaid. Their name is placed on a “do not do business with” list, and for all practical purposes, this means the end of their medical business.
CIAs and the Health Care Provider Obligation
CIAs place a heavy burden on the health care provider, and failure to comply with the terms brings heavy penalties.
Among the more popular components of a CIA are:
- Mandatory hiring of a permanent compliance officer;
- Written standard operating procedures for all activities;
- Extensive training and education activities for all employees;
- Hiring an Independent Review Organization (IRO) to double-check filed claims;
- Detailed retention of records (liable to inspection);
- Systematic claims review and validation;
- Numerous mandatory disclosures that includes tracking of excluded service providers; and
- A number of annual reports and certifications.
What Barraclough Interviews Reveal about a CIA
Our interviews indicate that providers which need to set up a CIA face a number of hurdles.
- The most significant complaint is the cost and complexity of putting everything into place and the inherent difficulty of designing the mandatory procedures that must be completely documented.
- This is done with a combination of legal expertise, feedback from the IRO, and use of consultants. None are particularly cheap, but the provider has no choice.
There is no standard CIA. Each one is customized to fit the particular circumstances of the provider.
Although there are a number of predictable complaints as the CIA is being put in place, our interviews reveal that after a time, the health care provider comes to appreciate its protection against further audits.
Please contact Barraclough Health (email to firstname.lastname@example.org) for further information on CIAs.