OIG raises the compliance program bar: What all providers need to know

Listen to article
11 minute read

Recent corporate integrity agreements (CIAs) and integrity agreements (IAs) include changes to the U.S. Department of Health & Human Services, Office of Inspector General (OIG) CIA and IA model language. These revisions reflect OIG’s evolving expectations concerning compliance program design and effectiveness and are noteworthy for all healthcare providers—not just those subject to integrity agreements. Among other changes, key revisions signal an increased focus on the compliance committee’s role in core compliance functions, compliance controls designed to promote compliance with the Stark Law and Anti-Kickback Statute, and how providers calculate overpayment refunds in connection with independent review organization (IRO) reviews.

The changes to the CIA model have implications for all providers. For providers currently under a CIA—while their existing CIA contractual requirements will not change—it is helpful to understand the evolution of the agency’s thinking because, for example, that may influence potential questions raised by their OIG monitor. For providers currently under a False Claims Act (FCA) investigation, it is important to understand the new CIA language to demonstrate relevant compliance controls and structure if negotiating with OIG to avoid a CIA, assess potential CIA obligations in the future, and evaluate the approach to CIA language negotiation strategy if a CIA is ultimately required as part of the resolution. Other providers can look to these CIA model requirements to understand agency expectations for compliance program design and oversight.

This document is only available to members. Please log in or become a member.
 


Would you like to read this entire article?

If you already subscribe to this publication, just log in. If not, let us send you an email with a link that will allow you to read the entire article for free. Just complete the following form.

* required field