OIG issues guidance on integrity agreements
The Department of Health and Human Services’ Office of Inspector General (OIG) last week issued guidance to help providers operating under corporate integrity agreements (CIA) meet their obligations. "These are frequently asked questions that we have had from people operating under CIAs," says OIG spokeswoman Alwyn Cassil. "We plan to add to these in the future."
CIAs typically are imposed on providers as part of the settlement for False Claims Act cases. "If providers don’t fulfill their obligations, they can be in violation," warns Cassil. "In many cases, we are now building stipulated penalties into these agreements, and they can also face exclusion."
The guidance includes an annual report checklist, including the reporting of federal health care program overpayments by providers under CIAs. "I liked the checklist very much," reports Chris Ideker, a partner with Ernst & Young in Atlanta. "We find that providers filing these reports have never done it before, so this really helps them structure these reports."
But Ideker warns that providers should be careful not to let this document override their obligations under a CIA. "Your CIA governs what you have to submit, not this document."
The guidance also includes an explanation about the "independence" of independent review organizations (IRO) for purposes of a CIA review. Ideker says it has been unclear who should be serving as an IRO and what their qualifications should be, as well as the nature of the report and the work papers supporting that document.
"Now, they specifically cite the AICPA [American Institute of Certified Public Accountants] guidance and the SEC [Securities and Exchange Commission] guidance," he reports. Ideker notes that the AICPA urged the OIG to consider "time-tested" definitions such as those last year. "They did not want to do that at the time, but they have definitely shifted their thinking. I think this gives people more guidance."
Ideker also notes that while costs related to the settlement of an investigation and integrity obligations cannot be included in cost reports, recent CIAs have started to require that IROs examine whether those costs have been improperly included. "That is a big issue," he warns. "They are now expecting IROs to evaluate that part, which was really an obligation from the settlement and not part of the integrity agreement beforehand." The OIG also is doing that at site reviews, he adds.
Most CIAs are in place five years and require measures to ensure the integrity of federal health care program claims. Such measures typically include:
- Hire a compliance officer/appoint a compliance committee.
- Develop written standards and policies.
- Implement a comprehensive employee training program.
- Audit billings to federal health care programs.
- Establish a confidential disclosure program.
- Restrict employment of ineligible persons.
- Submit a variety of reports to the OIG.
To promote self-disclosure among providers, the OIG earlier this year announced that in some cases it might scale back the size and scope of CIAs in lieu of existing compliance programs.
"I thought that letter was interpreted very incorrectly," says Ideker. "Providers still have integrity obligations; they are just imbedded in the settlement agreement." Moreover, those integrity obligations read very much like a CIA including training, monitoring, and sometimes even an IRO, he adds. "It is simply imbedded in the settlement agreement, and there is not an exclusion remedy for a material breach."
The OIG’s CIA annual report checklist and answers to frequently asked questions are available on the OIG Web site at www.hhs.gov/ oig/new.html.
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