A brief look at Corporate Integrity Agreements

Key Takeaway:

A corporate integrity agreement sets out the terms under which the Office of the Inspector General requires compliance with the conditions it sets out for healthcare providers/entities to facilitate settlement of civil false claims.

A corporate integrity agreement is an agreement that the Office of the Inspector General (OIG), which comes under the US Department of Health and Human Services (HHS), negotiates with healthcare provider/entity and related entities. This agreement is carried out for facilitating the settlement of Federal health care program investigations into civil false claims statutes.

A corporate integrity agreement requires providers/entities to inform the payor if any overpayments have been identified and made, and must also reimburse the overpaid amount as set out in the terms of the payor's policies.

How is a corporate integrity agreement worked out?

As part of this corporate integrity agreement, a provider/entity comes to an agreement as to their obligations. In return, the OIG on its part gives them the understanding that they will not be excluded from participating in Federal health care programs such as Medicare, Medicaid and others. A corporate integrity agreement thus is a contract between the OIG and provider/entity to contain the consequences of false claim statutes.

Most corporate integrity agreements signed with different provider/entity carry many common features. New changes required into a fresh agreement are brought in into a new agreement wherever these are necessary. The normal term of a comprehensive corporate integrity agreement is five years.

Requirements of a corporate integrity agreement

As mentioned, the requirements of most corporate integrity agreements are common, unless drastic changes are warranted with a particular provider/entity. In general, these are the expectations or requirements that a corporate integrity agreement has from provider/entity:

  • Whenever "reportable events" take place, the provider/entity must report this to the OIG within 30 days. A "reportable event includes:
  • An overpayment of a substantial amount
  • Anything that can be considered by a reasonable person as a potential violation of the administrative, civil, criminal laws relating to a Federal healthcare program that authorizes a penalty or exclusion
  • Employing or contracting what the corporate integrity agreement considers an Ineligible Person
  • Filing a bankruptcy petition.
  • Provider/entity has to hire a compliance officer or appoint a compliance committee
  • Written standards and policies have to be developed
  • A comprehensive employee training program has to be implemented
  • An independent review organization that conducts reviews annually has to be formed and retained
  • The provider/entity should report important events such as ongoing investigations/legal proceedings, overpayments, and reportable events
  • The provider/entity has to establish a confidential disclosure program
  • The corporate integrity agreement should ensure that employment of ineligible persons is restricted
  • The corporate integrity agreement should ensure that the provider/entity implements its compliance activities and report these, as well as give annual reports to the OIG
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