Because the HHS Office of Inspector General`s goal is to investigate fraud and abuse against the Medicare and Medicaid programs, it has the power to open transaction negotiations to prevent healthcare providers from entering into for fraud and abuse. For healthcare providers involved in a healthcare fraud investigation, entering into a corporate agreement (CIA) with the Office of Inspector General (OIG) is often a necessary condition for resolving this issue. Under the terms of the OIG Corporate Integrity Agreement, healthcare providers must accept a number of detailed compliance obligations. In return, they will have the opportunity to avoid exclusion from Medicare, Medicaid or other public health programs, which is a financially devastating outcome for any health organization. The Corporate Integrity Agreement (CIA) determines the time allowed for the selection and communication of the IRO to the OIG. Most agreements provide that this will be done within 60 to 90 days of the CIA`s entry into force. While compliance is complicated and typically costly, OIG Corporate Integrity Agreements leads companies through the implementation of an effective healthcare compliance program, which ultimately results in regular billing practices. This includes submitting accurate and complete claims to public health programs, appropriate agreements with physicians, and improving the quality of care provided to program beneficiaries. Since the OIG Corporate Integrity Agreement is a contractual agreement between the OIG and a healthcare organisation that obliges the organisation to comply with a defined set of compliance obligations, it is important to comply with all conditions. Violations of the OIG Corporate Integrity Agreement and non-compliance with obligations under the agreement can result in severe penalties, including possible exclusion from participation in public health programmes. A corporate integrity agreement (CIA) describes the commitments that a company has entered into in a civil transaction with the Office of Inspector General (OIG) in order to avoid exclusion from participation in Medicare, Medicaid or other health programs of the Confederation. The CIA have common elements, but each is tailored to the specific facts of the case.
The ICAs require the governing entity to withdraw a contract with an independent verification organization (IRO) in order to conduct audits of certain areas, depending on the nature of the terms of the agreement. For the most part, the IRO is responsible for confirming that the CIA`s conditions are being met. In most cases, the volume of the IRO`s work involves reviewing cost reports to determine whether ineligible costs have been included as part of reimbursement by publicly funded health programs. For the supplier, this means in essence that it is not permissible to include in a cost report or other report the costs incurred by the state investigation that leads to a payment by the government. . . .