JO - Health Care Compliance Association

More documents

Recommendations

Info

Editor’s note: Mike Walker, PhD, MA, MS, CHC is Chief Audit and Compliance Officer for the University of Connecticut and University of Connecticut Health Center. He may be reached by telephone at 860/486-0031. What is a CIA? Two fruits growing from the same tree Federal agencies, such as the Health and Human Services Office of Inspector General (OIG), negotiate compliance obligations with organizations or individuals as a result of an investigation. The OIG has exclusion authority based on 42 U.S.C 1320a-7(b) (7). What this means is the OIG has the authority to exclude the organization or individual from doing business with the federal government, thus the organization or individual loses all revenue from any federal program. This substantial “stick” provides a strong motivation for an organization to settle the allegations with the investigating agencies such as the Department of Justice (DOJ), U.S. Attorney, OIG, etc. The agreement, commonly called a Corporate Integrity Agreement (CIA), generally takes two forms: one is the actual “Settlement Agreement,” specifying the dollar amount and the other is the “Compliance Agreement,” which details the specifics relative to establishing a compliance program, auditing, annual reporting, etc. While certainly costly and significant, the former only hurts when writing the settlement check, but with the latter, pains of implementation are felt over multiple years. The overarching intent of the CIA is to bring the organization or individual By: Mike Walker, Ph.D., MA, MS, CHC into compliance with the applicable laws, regulations, etc. The OIG uses the CIA (a.k.a., Institutional Integrity Agreement) extensively in addressing allegations of health care fraud, particularly in cases involving Medicare and Medicaid dollars. As of this writing, there are more than 400 CIAs listed on the OIG Web site (http://oig.hhs.gov/fraud/cias.html). A small percentage of these are in academic medicine, more often related to improper billing or possible violation of the teaching physician rules. Similar lists may be found with other federal agencies related to research misconduct, for example, the National Institute of Health, Office of Research Integrity (http://silk.nih. gov/public/cbz1bje.@www.orlist.html). While some lists are predominantly institutional (e.g., CIAs and Excluded Party List System [EPLS]), others may contain individual names (e.g., List of Excluded Individuals/Entities [LEIE]). The latter lists are for debarment (exclusion from participation), while the OIG list specifically addresses settlement agreements that routinely allow the entity to continue to do business with the federal government. Institutional or entity debarment from receiving federal dollars is and can be the ultimate punishment imposed by a settlement action. The OIG and other federal agencies have used total debarment in a judicious and sparing manner. In the mid 1990s the OIG and other federal agencies launched a series of investigations called PATH audits (Physicians at Teaching Hospitals), and subsequently, a significant number of academic medical centers negotiated a CIA, which generally lasted five years, with the OIG. However, CIAs are not just The Announcement “While admitting no wrongdoing, (your organization) settled the case to avoid lengthy and costly litigation and to protect its ability to participate in Medicare, Medicaid, and federally funded grant programs. (Your organization) cooperated fully with the Federal Government to reach the settlement.” in health care or academic medicine. Like orange juice and breakfast, “CIAs are not just for health care anymore.” Other federal agencies, such as the Environmental Protection Agency (EPA), are using the CIA as a means of addressing violations as well. Copies of settlement agreements involving the EPA can be secured via their Freedom of Information Office at http://cfpub.epa.gov/compliane/ foia/readingroom/. The general requirements of the CIA mirror the Federal Sentencing Guidelines (Chapter 8) for establishing a compliance program (http://www.ussc. Continued on page 12 September 2006 10 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
You’re a compliance professional, which means you can’t rest at simply knowing one or two key areas when it comes to compliance matters. With the CCH Health Care Compliance Portfolio Deluxe you get the need-to-know information that affects every aspect of health care compliance. It comes as four resources (Health Care Compliance Professional’s Manual, Journal of Health Care Compliance, Health Care Compliance Reporter, and the Health Care Compliance Letter) that are designed to work seamlessly together. Visit health.cch.com or call 888-224-7377. When your company’s compliance steps rest on your decisions, look to Wolters Kluwer. Presenting the CCH Health Care Compliance Portfolio Deluxe. Health Care Compliance Association • 888-580-8373 • www.hcca-info.org September 2006 11 © 2006 Wolters Kluwer Law & Business. All rights reserved.
Page 1 and 2: Volume Eight Number Nine September
Page 3 and 4: ASK John asks the leadership your q
Page 5 and 6: the Health Care Compliance Associat
Page 7 and 8: Health Care Compliance Association
Page 9: Health Care Compliance Association
Page 13 and 14: A-110, or applicable regulation. n
Page 15 and 16: ogy, human resources, Erickson Adva
Page 19 and 20: is to make your hotel reservations
Page 21 and 22: September 2006 Health Care Complian
Page 25 and 26: those that have already enrolled in
Page 27 and 28: New Medicare enrollment regulations
Page 29 and 30: New Medicare enrollment regulations
Page 33 and 34: properly documented IRB or Privacy
Page 35 and 36: ment, on the theory that although d
Page 37 and 38: The Health Care Compliance Associat
Page 39 and 40: Register Today! Physician Practice
Page 41 and 42: They also are extremely credible an
Page 43 and 44: FYI ...continued from page 22 Sterr
Page 45 and 46: ■ William Munson, North Colorado
Page 47 and 48: ® SMART2.o : bringing HIM people a

JO - Health Care Compliance Association

Create successful ePaper yourself

Delete template?

Save as template?