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For agencies entering a CIA, it is important to ensure that the scope and scope of the agreement is clearly defined and defined in a concrete 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. Since the CIA is used as tools to promote model standards to ensure compliance with health legislation, health organizations should maintain their requirements after a typical five-year CIA mandate. Failure to comply with the terms of the OIG Corporate Integrity Agreement may result in additional sanctions, an extension of the terms of a CIA or an exclusion. If your organization is negotiating, implementing or managing a Corporate Integrity Agreement (CIA), strategic management can provide expertise that will help you meet CIA commitments. We have extensive experience in the CIA`s compliance with federal health regulations and we can help health organizations meet the important requirements and requirements of the CIA. The following discussions will focus on the requirements generally defined in a CIA: THE CIA is written and executed between the OIG and a health care provider or provider after an investigation by the DOJ and/or the OIG revealed that the health care provider or provider provided false information under the False Claims Act (FCA).

While cumbersome and often costly to complete, cement organizations lead to the implementation of an effective compliance program that will ultimately lead to appropriate billing practices, including the submission of accurate and comprehensive payment rights to federal health programs, appropriate agreements with physicians, and improved quality of care for program recipients. A Corporate Integrity Agreement (CIA) is a document that describes the obligations that a company working in the health sector in the United States performs with a federal authority or a state government under a civil scheme. At the federal level, the office of the Inspector General of the Department of Health and Justice Services and the Department of Justice are generally involved and, at the state level, the attorney general and state offices participating in Medicaid or Medicare are involved. [1] Managing the requirements of a CIA is never an easy task; it requires considerable human and financial resources to be able to successfully meet all its obligations. The first decisive step is to select the right IRO, as the company will work closely with this group of experts during the five years of the CIA. The lack of selection of an IRO with industry knowledge and experience of the IRO or surveillance could lead to a difficult relationship between the company and the IRO and a considerable increase in costs. As part of the CIA between HHS OIG and WellCare Health Plans, Inc., effective April 26, 2011, this managed care organization is required to name a compliance link to each of its seven major sites, which must be independent of the company`s legal department.