Kusserow on Compliance: OIG calls for more compliance expertise in reviewing CIAs

The HHS Office of the Inspector General (OIG) has recently increased oversight and accountability in their Corporate Integrity Agreements (CIAs). For years, a key requirement under CIAs involved engaging an Independent Review Organization (IRO) to oversee entity compliance with the substantive requirements. Years ago, IROs would also oversee the compliance program, but most have discontinued that practice and the government has relied upon the entity certifying/attesting to having implemented an effective compliance program.

More recently, the OIG has determined that enlisting an independent compliance expert to review the program is necessary. This also reinforced the increased emphasis on Board oversight of the entity. It is now common for a CIA to mandate that Boards engage a compliance expert to assist entities in meeting their obligation of the compliance program oversight. This is serious business as Board members are now being mandated to make certain personal certifications concerning the compliance program and compliance with the terms of the CIA. This was a topic widely discussed in sessions dealing with CIAs at the recent Health Care Compliance Association (HCCA) Compliance Institute in Las Vegas, Nevada.

Compliance experts engaged by Boards are required to have expertise in federal health care program compliance requirements and application of those requirements in order to develop a work plan. They must then issue a Compliance Program Review Report that addresses the defined issues, along with their recommendations for improvements or corrective actions. A copy of the report must be made part of each annual report under the CIA. Copies of materials provided by the compliance expert to the Board and minutes of meetings with them are to be made available to the OIG upon request.

All of this should not be surprising to anyone that has been following the OIG’s publicly stated positions on the subject. Calling for Boards to enlist compliance experts has been proposed by the OIG for some time. A year ago, the “Practical Guidance for Health Care Governing Boards on Compliance Oversight” was issued in conjunction with the American Health Lawyers Association (AHLA), HCCA, and the Association of Healthcare Internal Auditors (AHIA). It promoted the use of independent compliance experts by Boards and organizations to assist in evidencing an effective compliance program, as well as ensuring they meet all of their fiduciary duties and obligations in overseeing corporate compliance, whether or not a CIA is involved.

Steve Forman, CPA, who has years of experience as a compliance officer and has served on multiple occasions as a Board-engaged compliance expert observed that the Practical Guidance “provides almost identical language about Boards’ use of compliance experts as they do in CIAs today. Compliance Officers may be well advised to let their boards know about this trend.”

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on Google+ or LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2016 Strategic Management Services, LLC. Published with permission.