I know what you’re thinking. No, this isn’t that CIA. The Central Intelligence Agency could care less about your compliance violations. The Office of the Inspector General (OIG), however, may have something to say about it.
As we’ve seen, defrauding the government has consequences. On top of a civil settlement–or in some cases, jail time–a violation of the False Claims Act (FCA) requires a healthcare organization to enter a Corporate Integrity Agreement (CIA) with the OIG.
A CIA is a tool implemented to strengthen an organization’s compliance program with government-approved policies and procedures. The OIG wants to be sure that an organization will take steps to prevent future violations. Each agreement focuses on one or more categories of violations: claims review, focus arrangements, quality of care, and covered function review. They remain active for 3-5 years.
In the past, the OIG responded to all violations with a CIA. Now, however, the OIG will evaluate each violation on a case-by-case basis, assessing each violator’s capacity for change. Organizations deemed low-risk for future violations avoid this penalty. Factors the OIG takes into consideration include:
- Relevance: how long ago did the violations occur?
- Recurrence: was there a pattern of misconduct?
- Readiness: are there compliance procedures already in place?
If an organization self-discloses their violations, the OIG is much less likely to pursue a CIA. Self-disclosure is evidence of an already effective compliance program.
No one is exempt from CIAs. They can be issued to all types of healthcare entities–even individual physicians. Once issued, an organization is likely to accept a CIA in order to continue their participation in Medicare, Medicaid, or other Federal healthcare programs.
What can you do to avoid a CIA altogether? Check out MD Ranger’s Compliance Checklist, or email info@mdranger.com to get in contact with our experts.
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