OIG announces new guidelines for the imposition of CIAs - Updata - Office of the Inspector General; corporate integrity agreement standards for health care providers - Brief Article

Healthcare Financial Management, Jan, 2002

The consequences of an investigation by the HHS Office of Inspector General (OIG) are likely to be less onerous for healthcare organizations than in the past thanks to reforms announced by Inspector General Janet Rehnquist on November 20, 2001. In an open letter to healthcare providers, Rehnquist unveiled modifications to the corporate-integrity-agreement (CIA) and civil-recoveries processes that were designed with input from the provider community.

The OIG now will consider several new criteria for imposing a CIA and determining its stringency:

* Whether the provider self-disclosed the alleged misconduct;

* The monetary damage the provider violations did to Federal healthcare programs;

* Whether the case involves successor liability (ie, whether the CIA will be binding on any organization that assumes ownership of the provider);

* Whether the provider still is participating in Federal healthcare programs or in the line of business that gave rise to the fraudulent conduct;

* Whether the alleged misconduct could recur;

* When the alleged misconduct occurred;

* Whether the provider has a compliance program in place, would agree to limited compliance or integrity measures, and would annually certify such compliance to the OIG; and

* Other circumstances, as appropriate.

Rehnquist also expressed concern about the financial impact of CIAs on providers. To address these concerns, the OIG has modified the provisions of CIAs that cover billing reviews and the use of independent review organizations. Specifically, the new billing review policy will require the use of a full, statistically valid random sample only in instances where the "discovery sample" identifies an unacceptably high error rate. Providers currently under a CIA are eligible to incorporate the new claims-review requirements into their CIA.

The OIG has posted the full texts of all active CIAs on its Web site at http://oig.hhs.gov/cia/ciacurrent.htm. (Previously, the texts of the agreements were available only by mail from the OIG's Public Affairs office.)

To read Rehnquist's letter, go to http://oig.hhs.gov/ modcomp/openletters/openletter111901.htm. The letter also provides links to Web pages describing the new CIA claims-review procedures and providing answers to frequently asked questions about the CIA process.