Ever wonder if today is the day the Joint Commission shows up to begin its audit of your Human Resource compliance practices? How will you confidently demonstrate compliance with Joint Commission HR standards 01.02.01 with regard to staff qualifications and 01.02.05 with regard to verification of qualifications?

For most people, this causes waves of panic and uncertainty.

Will they find that you are compliant with your own internal requirement policies?  Do your HR files contain all of the primary source documentation that your policy requires?  Do you have a record of monthly OIG exclusion checks? Are you missing any key licenses, certificates, proof of MMR…? The list goes on and on. Failure of compliance in any one of these areas can result in the forced compliance of a CIA.

But no need to panic. Educating your organization on how to implement best practices will result in an “audit-ready” compliance plan as well as avoiding any potential CIAs.

What is a CIA?

A CIA is a Corporate Integrity Agreement. It is an agreement or a contract between you and the government (OIG). This action is part of the settlement of Federal healthcare program investigations arising under a variety of civil false claims statutes.

A CIA is a commitment to defined compliance obligations that are imposed in exchange for the OIG to not seek your exclusion from government programs. A CIA is a commitment by you the provider to very specific and defined compliance obligations that are going to be imposed in exchange for the OIG not to seek your exclusion from government programs. Most CIAs have typical terms, but focus on a specific area. The typical terms are things like a specified compliance officer and a compliance committee, written standard and policies, compliance training, confidential disclosure, screening for ineligible persons, reporting and repayment obligations, reports and IROs.

A comprehensive CIA typically lasts 5 years and includes requirements to:

  • Hire a compliance officer/appoint a compliance committee
  • Develop written standards and policies
  • Implement a comprehensive employee training program
  • Retain an independent review organization to conduct annual reviews
  • Establish a confidential disclosure program
  • Restrict employment of ineligible persons
  • Report over payments, reportable events and ongoing investigations
  • Provide an implementation report and annual reports to OIG on the status of the entity’s compliance activities

CIAs ensure transparency and open honest dialogue between you and the government.

How to Avoid a CIA –

When you want to avoid a CIA, decide whether you are want to have compliance in your organization now or have it later. A CIA is exactly that – compliance. It is forced compliance because of the understanding your company did not have compliance before.

Mandated requirements that comes with a CIA is that you conduct screening on ineligible persons. If you are NOT under a CIA, best practice according to the Affordable Care Act, CMS and OIG recommend, with guidance, that you search on a monthly basis for exclusions to ensure that you are not doing business with any one that is excluded. If you are under a CIA you do NOT have a choice whether or not you consider that a best practice AND you have additional requirements that are imposed on you.

8 Key Takeaways to Avoid a CIA – compliance now or later

  1. Ability to demonstrate an effective healthcare compliance program – monthly exclusion monitoring.
  2. Perform risk assessment and determine the level of risk – audit highest risk areas.
  3. Start program improvements as soon as you sniff trouble.
  4. Education is key. Education regulators during negotiation time. Re-educate staff on regulations and issues identified through auditing and monitoring efforts.
  5. Select an IRO that is experienced.
  6. Quality, Risk, Operations, Compliance – it’s a team sport.
  7. Educate and re-educate on policies and procedures to communicate awareness. Monitor compliance with laws, policies and regulations.
  8. Use CIAs as a training tool – a clear road map of regulatory expectations.

Healthcare compliance audits are here to stay but there is no need to panic. For most organizations, the issue is simply having to go to one place to locate, manage and demonstrate compliance. In the Joint Commission audit, they will ask for current licenses, certificates, MMR records, Continuing Education, as well as several other documents.

Healthcare HR compliance tools exist to help your organization be proactive and audit-ready for any visit (announced or not) by the Joint Commission – at all times.

What does your organization do to remain audit-ready? Comment Below

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Michael Rosen, ESQ

Written by Michael Rosen, ESQ
ProviderTrust Co-Founder, mrosen@providertrust.com

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
Connect with Michael on Linkedin

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