We are pleased to welcome a guest today on the blog – Harold Malkin, a former Assistant U.S. Attorney who specialized in the resolution of civil healthcare fraud cases involving individual providers, medical practices and institutional providers in the Western District of Washington in Seattle for over 15 years. In this article, Harold will highlight some important information regarding the permissive and mandatory exclusion authority of the Office of Inspector General (OIG) as well as some things to consider if you find yourself in settlement discussions with OIG.
There are many people who can share their perspectives on negotiating a Corporate Integrity Agreement, all with a variety of backgrounds and experiences.
There are many misunderstandings in the compliance world on how CIAs are used and whether or not the OIG is obligated to enter into one. The OIG does not have to enter into a Corporate Integrity Agreement, nor does a provider have an automatic right to one.
A CIA is a serious weapon available to the OIG to resolve allegations of fraud and abuse. Let’s take a look back at some of the history of Corporate Integrity Agreements and how they are used.
As we all know, Corporate Integrity Agreements (CIA’s) are an excellent resource to a compliance officer when trying to stay ahead of the ever-changing compliance landscape. CIA’s provide a wealth of information as to what the Office of Inspector General (OIG) believes should be elements of an effective compliance program. They can also help clarify roles and responsibilities of the board or senior leadership in a healthcare organization. It is highly recommended that you monitor CIAs posted on the OIG site on a periodic basis to see if the model CIA has been updated or changed.
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.
The first thing you should do is realize that the clock is already ticking and you need to start preparing. There are many phases to implementing a Corporate Integrity Agreement (CIA) but Phase I actually starts before the CIA is even signed.
Effective compliance planning is demonstrated and driven by outcome.
The most important step in creating an effective compliance plan for your organization is to be proactive in actually implementing its terms. Leaving a compliance plan on a shelf collecting dust, as if an afterthought, sends the wrong message to prosecutors especially if an audit of your organization should find any excluded individuals or entities, or other non compliance.
The first steps towards compliance are having a plan in place. In some respects, that is the easy part. Not only is it required to have a compliance plan in some fields of healthcare, but it is also a building block for an organization’s compliance success.
This just goes to show it’s not just words on paper, but it is a document outlining how you will be held responsible for adhering to its terms. Not adhering to its terms can lead to a forced Corporate Integrity Agreement (CIA) with the OIG along with hefty fines.