Kusserow on Compliance: OIG announces changes in provisions in corporate integrity agreements

Free Upcoming Webinar! Compliance Accountability: Lessons Learned From Implementing Corporate Integrity Agreements

At the now-concluded Health Care Compliance Association (HCCA) conference, representatives of the HHS Office of Inspector General (OIG) spoke about the changing provisions in the OIG’s Corporate Integrity Agreements (CIAs). They provided an up-to-date perspective on the agency’s priorities and concerns, as well as what they individually believe is necessary for effective oversight and operational controls for health care organizations. Many of the provisions included in new CIAs have been included for many years, but there are also many evolving provisions that have been added. CIAs include a stipulated penalty for each day the organization is out of compliance with deadlines and a $50,000 penalty for each false certification. As with any representations to the government, any false certification may implicate the False Claims Act. Compliance Officers need to understand what CIA requirements are, in order to brief executive leadership and the Board on what is expected of them by the OIG. Failing to meet the obligations under the agreement can result in severe penalties, including possible exclusion of participation in federal health care programs.

Evolving provisions

The upcoming free webinar on Compliance Accountability: Lessons Learned From Implementing Corporate Integrity Agreements will address these evolving provisions in the CIAs and will be a great takeaway for use in educating executive leadership and Boards on what is expected of them in supporting and providing oversight for their Compliance Program. Register today!

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.

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Copyright © 2017 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: OIG warns board of consequences for failing to meet compliance oversight responsibilities

CIAs are rapidly changing with additional provisions that include Board members

Upcoming webinar will address the full range of changes in CIAs

At the Health Care Compliance Association (HCCA) conference just concluding, the HHS Office of Inspector General (OIG) warned that in working out terms and conditions of a Corporate Integrity Agreement (CIA), the OIG will look for evidence of whether the Board was actively involved in oversight of the compliance program. If it determines that the Board was derelict in meeting its fiduciary responsibilities, the OIG will consider that a contributing factor that led to the need for government intervention. The weaker the Board oversight, the more stringent the requirements that are placed on the Board in the settlement agreement. In cases where the OIG finds that the Board has not been providing the proper oversight of the compliance program, the OIG will add mandates for personal certifications of Board members regarding the compliance program that includes mandated certifications by individual Board members on the effectiveness of the program. To ensure that Boards are attentive to this responsibility, the OIG may require the Board to engage a Compliance Expert to assist in meeting the Board’s obligations and the report made part of each Annual Report filing. These provisions place a heavy personal burden on Boards. Furthermore, CIAs often include a stipulated penalty for non-compliance with deadlines, as well as $50,000 penalties for each false certification that may also implicate the False Claims Act.

For 20 years, the OIG has been calling for a “top-down” compliance program, beginning at the Board level, that includes issuing White Papers, such as “Practical Guidance for Health Care Governing Boards on Compliance Oversight,” and emphasizing holding Boards more accountable for proper oversight of compliance within organizations. Language from these pronouncements about Board obligations and use of Compliance Experts is now included in CIAs.

Tips for Compliance Officers

  1. Review OIG “White Papers” and new CIAs to lean what the OIG considers as best practices for boards
  1. Educate and warn the Board on their fiduciary obligations and personal consequences for failing to meet them.
  1. Suggest the Board include someone who is “compliance literate” that knows what questions to be asked and assess program effectiveness (e.g., compliance officer experience or a compliance consultant).
  1. Provide the Board with solid evidence concerning the operation of the compliance program, such as engaging a Compliance Expert to assess and evaluate the program and providing the Board with evidence of an active program and identifying opportunities for improvement.

Register now to attend a free webinar on Thursday, April 6, 2017 titled “Compliance Accountability: Lessons Learned from Implementing Corporate Integrity Agreements” and presented by Thomas Herrmann, JD, former Chief of the Litigation Branch for the OIG and Appellate Judge for Medicare Appeals, along with Carrie Kusserow, MBA, CHC, CHPC, CCEP, who has 15 years’ experience as a compliance officer and consultant. Both are experts on compliance programs, as well as meeting the terms and obligations of Corporate Integrity Agreements.

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 © 2017 Strategic Management Services, LLC. Published with permission.