Corporate Integrity Agreement Violations

2 The CSHM`s failure to comply with certain CIA obligations could lead to prison sentences, including, for example, a $50,000 fine for any false certification filed by CSHM or on behalf of CSHM. See FORBA Holdings, LLC Corporate Integrity Agreement, p. 46 (January 15, 2010), available at „Paying any kind of illegal compensation to transfer patients undermines the integrity of our country`s health care system,“ said Assistant Attorney General Jody Hunt of the Justice Department`s Civil Division. „When a patient receives a prescription for a device to treat a medical condition, the patient deserves to know that the device was chosen on the basis of quality of care considerations and not on the basis of irregular payments made by device manufacturers.“ A CIA is essentially a contract between a health facility and the OIG. Under a CIA, a health care provider undertakes certain compliance obligations under a civilian plan for its future participation in federal health programs, in exchange for the OIG`s agreement not to exclude the provider or provider of Medicare, Medicaid and other federal health programs under its legal authority. A CIA generally has a five-year term and is intended to „ensure the integrity of federal health program claims submitted by [a] provider in the coming years.22 Corporate Integrity Agreements (CIA) negotiated and concluded by the Office of Inspector General (OIG) have certain standard compliance requirements. In accordance with the United States Sentencing Commission`s Federal Guides Manual, the CIA generally handles the seven key elements of an effective compliance program. Typically, each CIA begins with a statement outlining the reason for the health sector`s conclusion of the agreement. The statement confirms the supplier`s desire to uphold high standards of business ethics and to require the same from all employees, managers, agents, contractors, etc. It also reaffirms the provider`s commitment to meet the requirements to participate in Medicare, Medicaid and all other federal health programs. Then we define the term and scope of the CIA, usually five years.

The scope provides detailed instructions on who and entities are subject to CIA conditions. These are usually executives, directors, staff, contractors and representatives of the organization. During the life of the CIA, the organization must comply with CIA conditions or risk violating the contract and being responsible for detailed fines in the CIA, as well as an extension of the period of exclusion from participation in public health and public health programs. THE ICAs also include an agreement from the organization to respect the fundamental elements of a compliance program, which include that for companies that enter into a CIA, it is important to ensure that the scope and breadth of the agreement are clearly defined and defined in a specific way. In most cases, compliance program and claims audits are fairly simple, as long as the parameters of what constitutes an „error“ are predefined. However, in some cases, ICCs are developed in response to alleged problems or faults that require evaluation and monitoring of the program instead of conducting damage audits. Before reaching a final agreement with the CIA, it is advisable to have an expert in the field who will ensure that the conditions are clear within the framework of the CIA and that the IRO is also well defined. The first case in which the OIG continued a custion operation took place as part of the comprehensive resolution of a US DOJ investigation into Synthes and its United States.

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