Corporate Integrity Agreement Meaning

This article contains public domain material from the U.S. Department of Health and Human Services document: Corporate Integrity Agreements Snapshot (PDF). Call on April 14, 2018. Under the Company Integrity Agreement, not all surcharges and events are considered to be declared. The OIG requires suppliers to report these events as a significant overpayment, an unauthorized person with access to confidential information or any event that a reasonable person would consider a violation of civil or criminal law. If the practitioner has filed for bankruptcy, this is an event to be declared. Depending on the circumstances, reports of isolated or unique incidents or for a series of events may be submitted. A Business Integrity Agreement is a legally binding agreement between the Department of Health and Health Services and a private health care provider that is linked to a federal case of fraud under a public health program such as Medicare or Medicaid. With this agreement, physicians can continue to process and accept Medicare and Medicaid claims as long as they comply with the specific guidelines set out in the agreement.

This agreement is only used in civil cases in which Medicare and Medicaid were involved, and not in criminal cases where similar charges are made. A CIA is usually entered into in connection with a civil agreement between the U.S. government and a health care provider or health organization under the False Claims Act, or when an organization has been convicted of defrauding the Centers for Medicare and Medicaid Services (CMS) or any other federal health program. The CIA is negotiated and monitored through the office of the Attorney General of the Department of Health and Human Services. The agreements must be consistent with the 1995 federal guidelines, while reflecting the size and size of the supplier, as well as the concrete assertions that have been made to the CIA. While the details of an agreement are specific to each case, several elements often appear in all documents. The supplier must include standard policies and procedures and appoint a compliance committee to ensure that the rules are followed. It must set up a staff training program.

People who are not considered to have the right to process sensitive information must have limited access. Finally, the supplier must immediately report the overpayments received and submit an annual report to the Office of Inspector General responsible for overseeing the case. Some CLAs ask an independent organization to verify and monitor compliance with CIA conditions. Most CLAs require harm checks to identify errors and their underlying causes. [1] The government authority can verify compliance through on-site visits. [1] If a company violates the agreement, the Agency can fine it and, if the problems cannot be resolved, the supplier may be excluded. [6] A Corporate Integrity Agreement (CIA) is a document that describes the obligations that a U.S. health care company performs with a federal authority or a state government under a civilian regime.