Does a CIA provider have to report All overpayments to OIG?
Although all identified overpayments should be refunded to the appropriate payor, a provider under a CIA does not need to report to OIG all identified overpayments at the time it reports such amounts to the payor. However, the provider must report to OIG within 30 days all "reportable events" as defined by the CIA.
Will OIG continue to work with the Department of Justice?
“OIG will continue to work closely with the Department of Justice to investigate and pursue kickbacks regardless of the form they take,” said Gregory E. Demske, Chief Counsel to the Inspector General, HHS-OIG.
What is the Novartis settlement with Medicare?
The first settlement pertains to the company’s alleged illegal use of three foundations as conduits to pay the copayments of Medicare patients taking Novartis’s drugs Gilenya and Afinitor. The second settlement resolves claims arising from the company’s alleged payments of kickbacks to doctors.
Does OIG conduct site visits for CIA monitoring?
OIG monitors hundreds of providers, practitioners, suppliers, payors, and other entities that operate under CIAs. Since 1999, we have conducted site visits as part of our CIA monitoring efforts. The following are frequently asked questions regarding these site visits. What is the purpose of a site visit?
What is corporate integrity agreement with OIG?
An integrity agreement (IA) is a document that outlines the obligations to which an individual practitioner, small group practice, or small provider agree as part of a civil settlement. Where can I find an entity's Corporate Integrity Agreement? The OIG Web site contains copies of current CIAs and IAs.
What is a CIA for Medicare?
Agreements Snapshot. A Corporate Integrity Agreement (CIA) is a document outlining the obligations a corporate provider agrees to as part of a civil settlement.
What 3 elements are part of the corporate integrity agreement?
Corporate Integrity Agreementshire a compliance officer/appoint a compliance committee;develop written standards and policies;implement a comprehensive employee training program;retain an independent review organization to conduct annual reviews;establish a confidential disclosure program;More items...
How long does a corporate integrity agreement last?
CIAs generally last 5 years. During this time the provider is usually required to implement or expand a comprehensive employee training program, a confidential disclosure program, written standards and policies, and designate a compliance officer and committee if these things are not already done.
What is OIG self disclosure protocol?
OIG's contractor self-disclosure program enables contractors to self-disclose potential violations of the False Claims Act and various Federal criminal laws involving fraud, conflict of interest, bribery or gratuity.
Why might an organization be required to submit and follow a CIA?
The purpose of a Corporate Integrity Agreement (CIA) is to improve the quality of health care and promote compliance with health care regulations; they are not meant to be punitive but instead to drive compliant behavior and set minimum standards for which a health care provider/entity should be held accountable.
What is the OIG compliance program?
OIG has developed a series of voluntary compliance program guidance documents directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers, to encourage the development and use of internal controls to monitor adherence to ...
What are the 7 elements of a compliance program?
Seven Elements of an Effective Compliance ProgramImplementing written policies and procedures. ... Designating a compliance officer and compliance committee. ... Conducting effective training and education. ... Developing effective lines of communication. ... Conducting internal monitoring and auditing.More items...
What is considered to be a reportable event as defined by the CIA?
Providers under a Corporate Integrity Agreements (CIA) or Integrity Agreements (IA) with the OIG are required to disclose certain "Reportable Events" which include: a substantial overpayment, a matter that a reasonable person would consider a probable violation of criminal, civil, or administrative laws applicable to ...
What does the OIG monitor?
OIG monitors and tracks the use of taxpayer dollars through audits, inspections, evaluations, and investigations. The Inspector General keeps the Secretary of Commerce and Congress fully and currently informed about problems and deficiencies relating to Commerce's activities and the need for corrective action.
Does the CIA have an inspector general?
The Office of Inspector General (OIG) is responsible for independent oversight of the CIA.
Which entities enforce Healthcare Compliance?
CMS is charged on behalf of HHS with enforcing compliance with adopted Administrative Simplification requirements....Enforcement activities include:Educating health care providers, health plans, clearinghouses, and other affected groups, such as software vendors.Solving complaints.Conducting proactive compliance audits.
What is OIG compliance?
OIG's compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with Federal health care program standards. OIG also issues advisory opinions, which cover the application of the Federal anti-kickback statute and OIG's other fraud and abuse authorities to ...
What is OIG in healthcare?
To help healthcare providers such as hospitals and physicians comply with relevant Federal health care laws and regulations, OIG creates compliance resources, which are often tailored to particular providers.
What happens to a provider's CIA?
A provider's CIA or IA may be terminated early in the event that the provider ceases participating in the Federal health care programs or ceases its operations altogether as a result of a closure, sale, bankruptcy, etc.
What happens if a provider is under a corporate integrity agreement (CIA) or integrity agreement (IA)
What happens if a provider that is under a corporate integrity agreement (CIA) or integrity agreement (IA) is sold during the term of the CIA or IA?#N#In the event that, during the term of its CIA or IA, the provider decides to sell any or all of its business that is subject to the CIA or IA ( whether through an asset sale, a sale of stock, or other type of transaction), the CIA or IA shall be binding on the purchaser of the business unless the provider obtains a written determination from OIG that the proposed purchaser and the business will not be subject to the requirements of the CIA or IA following the clo sing of the transaction. To obtain such a determination, the provider must notify OIG in writing at least 30 days in advance of the proposed sale and provide a description of the business being sold, the terms of the transaction, and the identity of the prospective purchaser. A determination regarding successor liability will depend on the facts and circumstances of the proposed transaction and other information determined to be relevant by OIG.
What is the OIG reportable event?
OIG defines the term "reportable event" in its CIA by noting that it could be:#N#a substantial overpayment,#N#a matter that a reasonable person would consider a probable violation of criminal, civil, or administrative laws applicable to any Federal health care program for which penalties or exclusion may be authorized;# N#the employment of or contracting with an ineligible person (as defined in the CIA); or#N#the filing of a bankruptcy petition.#N#Such a situation may be the result of an isolated event or a series of occurrences. Therefore, a provider under a CIA must determine if an identified matter requires disclosure under the CIA based on the totality of the facts and the context of the surrounding circumstances. OIG believes that a percentage or numeric threshold simply constitutes the initial step in determining materiality and therefore reliance solely on such a rule of thumb threshold is inappropriate and should not replace a detailed analysis of all the relevant facts and circumstances.
What is OIG's policy regarding the reporting of Federal health care program overpayments by providers?
What is OIG's policy regarding the reporting of Federal health care program overpayments by providers under corporate integrity agreements?#N#Providers under CIAs must promptly notify the appropriate payor of all identified overpayments and must promptly repay the overpayment amount in a manner consistent with the payor's policies and in accordance with 42 U.S.C. § 1320a-7k (d) and 42 C.F.R. §§ 401.301-305 (the CMS overpayment rule). Providers under CIAs are expected to develop and implement written policies and procedures to ensure that overpayments are identified, quantified, and repaid in accordance with the CMS overpayment rule and other applicable Federal health care program requirements. Although all identified overpayments should be refunded to the appropriate payor, a provider under a CIA does not need to report to OIG all identified overpayments at the time it reports such amounts to the payor. However, the provider must report to OIG within 30 days all "reportable events" as defined by the CIA. A "reportable event" generally means anything that involves:#N#a substantial overpayment;#N#a matter that a reasonable person would consider a potential violation of criminal, civil, or administrative laws applicable to any Federal health care program for which penalties or exclusion may be authorized;#N#the employment of or contracting with an ineligible person (as defined in the CIA); or#N#the filing of a bankruptcy petition.#N#A reportable event may be the result of an isolated event or a series of occurrences.
How long does a provider have to report overpayments to OIG?
However, the provider must report to OIG within 30 days all "reportable events" as defined by the CIA.
What is OIG monitoring?
OIG monitors hundreds of providers, practitioners, suppliers, payors, and other entities that operate under CIAs. Since 1999, we have conducted site visits as part of our CIA monitoring efforts. The following are frequently asked questions regarding these site visits.
What is a corporate integrity agreement?
What is a Corporate Integrity Agreement?#N#A corporate integrity agreement (CIA) is a document that outlines the obligations to which an entity agrees as part of a civil settlement. An entity agrees to the CIA obligations in exchange for the Office of Inspector General's (OIG) agreement that it will not seek to exclude the entity from participation in Medicare, Medicaid, or other Federal health care programs. CIAs have common elements, but each one is tailored to address the specific facts of the case and may incorporate elements of a preexisting compliance program.#N#An integrity agreement (IA) is a document that outlines the obligations to which an individual practitioner, small group practice, or small provider agree as part of a civil settlement.
Why are Medicare payments risk adjusted?
To accommodate costs that may be associated with patients that require more care than an average patient, Medicare payments to MA plans are “risk adjusted” to reflect, in significant part, the health status of the beneficiary.
What is Medicare Advantage?
Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in and obtaining health care from Medicare Advantage Plans (MA Plans) that are owned and operate d by private Medicare Advantage Organizations (MAOs).