How Does A Corporate Compliance Program Differ From A Corporate Integrity Agreement

Hundreds of health care providers and plans that have entered into fraud agreements with the Department of Justice (DOJ) have also entered into Business Investment Agreements (CIA) with the HHS Office of Inspector General (OIG), which provide that the provider of health services to be billed uses an independent monitoring organization (IRO) to monitor the provider`s compliance with CIA terms and verify compliance with it. the areas of government rules have been adopted. Inquiry. In some cases, the DOJ will appoint an instructor who, in his duties and responsibilities, will be similar to that of an IRO. There are more than 300 CIAs that have been negotiated with the OIG in recent years and that have required an IRO to monitor compliance with the terms of the agreement. These CIAs most often result from a settlement of a civil case of false claims with the DOJ and are now a common feature in the health landscape. It is important to note that the OIG does not choose the IRO. In addition, they do not give advice on selection and do not support organizations that are IRO. It is entirely up to the entity or supplier to determine the most appropriate organization to engage as an IRO. However, the OIG reserves the right to approve or refuse the choice of the IRO by the companies or the supplier within 30 days of receipt of the written notification of the IRO`s identity to the OIG. As a rule, companies such as consultants, accounting firms (CPAs) or law firms are tasked with performing such tasks.

While most health organizations that have entered into settlement agreements with the DOJ have spent a lot of time, effort, and money on an agreement, they have had relatively little concern about the process of selecting an IRO that would be approved by the OIG. In many cases, this has led to further problems and aggravations. The following discussion should help any organization facing the prospects of a CIA to think about how to find and select a qualified IRO. Typically, ICAs require the vendor to implement a compliance program that complies with the compliance guides published by the OIG. 2 As healthcare industry awareness and commitment to compliance has increased over the past decade, a large number of healthcare providers have voluntarily implemented compliance programs without direct government intervention. Despite the independent implementation of compliance programs, several health care providers have negotiated with the government to respond to allegations that they have violated federal fraud and abuse laws, such as false Claims Act3, Civil Monetary Penalties Law4 or the Fraud Civil Remedies Act5 program. instead of a formal CIA as part of the release of the executing authority from its permissible exclusionary power. . . .