Compliance Integrity Agreement

The CLAs usually last five years. During this period, the supplier is generally required to implement or expand a comprehensive staff training program, a confidential disclosure program, written standards and guidelines, and to appoint a compliance officer and a committee if this has not yet been done. [5] The CIA is also responsible for setting up procedures for the management and reporting of “events to be reported”. Events to be reported include ongoing overpayments, investigations or court proceedings, possible violations of criminal, civil or administrative laws applicable to a federal health program that may be sanctioned or excluded, and employment or contract with an ineligible person. [1] In addition to the false certification sanction, the flags contain infringements and default provisions that allow the OIG to impose daily penalties (usually $1,500 per day) for the practitioner`s non-compliance with fine duty, including (among other things) the non-application of the various requirements of the compliance program, the non-presentation of required reports and the non-attribution of access to the OIG to the books. , registrations and staff required to verify the practitioner`s compliance with FAS. In addition, the OIG may find a practitioner who, for certain offences, contains a practitioner in material violation of the fable, including the non-reporting of an “event to be reported”, repeated violations or a flagrant violation of FABEL`s obligations and the non-use and use of an IRO. The consequences of a material offence are serious – The practitioner`s exclusion from participation in federal health programs. The company includes rights of appeal for penalties imposed and any finding of a substantial infringement, including the right to seek to be heard by an administrative judge. A Corporate Integrity Agreement (CIA) is a document that describes the obligations that a company working in the health sector in the United States performs with a federal authority or a state government under a civil scheme.

At the federal level, the office of the Inspector General of the Department of Health and Justice Services and the Department of Justice are generally involved and, at the state level, the attorney general and state offices participating in Medicaid or Medicare are involved. [1] Richard P. Kusserow founded Strategic Management Services, LLC, to help health organizations develop, implement and evaluate compliance programs. Mr. Kusserrow has worked with health organizations to conduct evaluations of the effectiveness of compliance programs, provide consulting services, develop policies and procedures, and conduct compliance and internal audit investigations. In exercising its authority to exclude a health facility from participation in federal health programs, the IGO assesses the seriousness of the allegations, the completeness of the company`s existing compliance program, and the steps taken to improve the compliance program to avoid future repetitions and misconduct when voluntary self-reporting has been made, and the weight of evidence supporting allegations of fraud.