What is a Corporate Integrity Agreement?
A Corporate Integrity Agreement (CIA) is a document that outlines the obligations in which a healthcare entity agrees to a civil settlement with the Office of Inspector General (OIG) to resolve an allegation of fraud.
If the OIG is agreeable to resolve the matter, then a CIA is entered into in exchange for the OIG not seeking to exclude the entity from participation in Medicare, Medicaid, CHIPS or other federal health care funded programs.
What's included in a CIA?
A CIA specifically outlines compliance requirements that the entity must implement, follow and be held accountable to during the term of the CIA. The CIA is in effect for a defined term, typically five years. Although most of the CIA's contain common elements, each is tailored to address certain facts surrounding the case and may incorporate parts of a pre-existing compliance program.
A CIA also contains penalties for non-compliance specified as monetary penalties (called stipulated penalties) that can be imposed on a per day basis if the organization fails to comply with the CIA requirements. Certain violations are considered a 'material breach' of the CIA, such as failure to engage and use an independent review organization (IRO) and/or repeated violations of CIA obligations.
The OIG publishes executed CIA's on its site. These CIAs can be very helpful to review as you evaluate your compliance program.
Components of a Corporate Integrity Agreement
The core sections of a CIA typically include:
1. Term and Scope
2. Corporate Integrity Obligations which outlines many important requirements such as:
- Responsibilities of the Compliance Officer
- Composition of the Compliance Committee
- Board responsibilities
- Written standards requirements
- Training requirements
- IRO or Quality Monitor requirements
- Reporting obligations
3. Successor Liability: Changes to Business Units or Locations
4. Implementation and Annual Reports
5. Notification and Submission of Reports
6. OIG Inspection, Audit and Review Rights
7. Document and Record Retention
9. Breach and Default Provisions
10. Effective and Binding Agreement
HCCA Compliance Institute
At the recent HCCA Annual Compliance Institute, a senior member of the OIG commented, that the purpose of a CIA is to protect the integrity of CMS dollars as well as ensure ongoing compliance and oversight of healthcare companies that have reached the OIG radar for alleged fraud related matters. The OIG reiterated that the goal of a CIA is to help an organization resolve a pending matter and to set in place, and be held accountable for, certain minimum required compliance requirements.
The CIA is not there just to memorialize the seven elements of an effective compliance plan, without teeth. A positive outcome of a CIA she stated, is to teach a provider about self-assessment and good compliance governance. The speaker referred to this as efficient and effective oversight by the OIG and an IRO.
A Valuable Resource
Written by Donna Thiel, Director of Compliance Integrity Team
Donna Thiel is the Director of our Compliance Integrity team, a consulting division of ProviderTrust. Donna works with compliance officers across the country to help reduce the stress and anxiety of this very difficult role.
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