As the goal of the HHS Office of Inspector General is to investigate fraud and abuse of the Medicare and Medicaid programs, it has the power to initiate settlement negotiations to prevent health care providers from being prosecuted for fraud and abuse. For health care providers involved in an investigation into health fraud, reaching an Enterprise Integrity Agreement (CIA) with the Office of Inspector General (OIG) is often a necessary condition for resolving the problem. In accordance with the provisions of the OIG Corporate Integrity Agreement, health care providers must accept a number of detailed compliance obligations. In exchange, they will have the opportunity to avoid the exclusion of Medicare, Medicaid or other federal health programs, which is a financially devastating outcome for any health organization. While the OIG Corporate Integrity Agreement focuses on the specific failure of the organization`s or health care provider`s compliance, all ICAs have commonalities. A full CIA typically lasts five years and requires the organization to improve its compliance program through the development, implementation and monitoring of different areas of compliance. In addition, public health organizations are required to assign an independent audit organization (IRO) to conduct annual audits and assessments. Although cumbersome and generally cumbersome and costly to complete, OIG Corporate Integrity Agreements leads organizations to implement an effective public health compliance program that ultimately leads to proper billing practices. These include submitting specific and comprehensive payment requests to federal health programs, appropriate agreements with physicians, and improving the quality of care provided to program recipients.
Since the OIG Corporate Integrity Agreement is a contractual agreement between the OIG and a health organization requiring the organization to meet a defined set of compliance obligations, it is important to meet all conditions. Violations of the OIG Corporate Integrity Agreement and non-compliance with obligations under the agreement may result in severe penalties, including the possible exclusion of participation in federal public health programs. The annual report will keep the OIG informed of the supplier`s compliance activities for the duration of the agreement. It includes health compliance activities and the results of the IRO audit of the organization`s compliance with the provisions of the OIG Corporate Integrity Agreement. The annual report contains, among other things, a description of all audits, audits or analyses of the Organization`s compliance program, the Organization`s response to such audits, audits or analyses, and a summary report on any overpayments made during the period.