IRO Claims Reviews Revisited

Healthcare entities that enter into corporate integrity agreements (CIAs) or integrity agreements (IAs) with the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) typically have various corporate integrity obligations. These obligations often mandate the engagement of an Independent Review Organization (IRO) and in some cases also a compliance expert to the Board. The IROs most often must conduct either claims reviews or arrangements reviews, or both. IROs must be professionally independent and objective and follow the most recent Government Auditing Standards issued by the U.S.  Government Accountability Office (GAGAS or Yellow Book standards).

About the Author

Dr. Cornelia M. Dorfschmid has over 30 years of private and government sector experience in health care compliance consulting, the majority of which was in management and executive capacities. She is a recognized expert in the areas of claims auditing, overpayment analysis and risk management and corporate health care compliance.