Corporate Integrity Agreements Terms and Conditions

Standard and evolving provisions

Much can be learned from knowing what is expected under a CIA

Corporate Integrity Agreements (CIAs) are among the most important methods used by the OIG to promote healthcare compliance. CIAs impose controls directly on providers seeking to resolve government investigations so that they continue to receive reimbursement under federal health care programs and avoid the OIG excluding the organization from participation in federal health care programs. The OIG seeks assurance that the organization can be relied upon to operate in accordance with applicable laws and regulations. At any given time, there are over 300 such agreements in force, with most of them being for a five year period; many are in the process of being developed. Some of the provisions included in CIAs have been in place for many years, but there are evolving new provisions being added. Meeting all of the terms and conditions in a CIA is very important, as it is a contractual agreement between the OIG and an entity that commits the entity to undertake a defined set of compliance obligations. Failing to meet the obligations under the agreement can result in severe penalties, including possible exclusion of participation in federal health care programs. CIAs also often include a stipulated penalty for each day an organization is out of compliance with deadlines and a $50,000 penalty for each false certification. As with all representations to the government, any false certification may implicate the False Claims Act.

For compliance officers, it is worthwhile to understand mandated provisions, as they reflect what the OIG really expects in an effective compliance program. It is therefore valuable to provide guidance regarding those areas that should receive the most attention. The following outlines those provisions that have been evolving over the last couple of years.

Evolving Provisions

• OIG increasing oversight and accountability of CIAs
• Increased responsibilities of Independent Review Organizations
• Adding more requirements for executives and Boards
• More Certifications by Boards, CEOs, executives, and compliance officers
• Boards hire a Compliance Expert to assist with compliance program review
• Increased focus on effectiveness of the compliance programs
• Increasing role and scope of the Independent Review Organization (IRO)