OIG gets mixed reviews on CIA requirement update
OIG gets mixed reviews on CIA requirement update
The Department of Health and Human Services Office of Inspector General (OIG) has posted 23 new answers to questions frequently asked by providers under a corporate integrity agreement (CIA) about reporting overpayments, the selection and independence of an independent review organizations (IRO) as well as material violations. But health care attorneys say the new guidance is a double-edged sword.
Mike Kendall, a health care attorney with McDermott, Will & Emory in Boston, says the OIG's latest notice demonstrates both the best and worst features of the OIG's approach to CIAs.
On one hand, he says there is some very precise information regarding auditing, sampling, and other tasks that providers will find very helpful. Also, the OIG makes a significant effort at industry education by offering carefully thought-out recommendations and standards.
But Kendall says there is a flip side to that coin. "Some of the standards included in the notice are ambiguous enough that providers should be concerned," he warns.
The most recurrent problem, he says, is the definition of a material violation (which is what a reasonable person would consider a potential violation of a criminal, civil, or administrative law). "That is a very broad and ambiguous definition and to put that onus on providers without any precise definition of how to deal with that threat is troubling," he asserts.
Moreover, Kendall says the OIG's notice is part of a process the OIG is using to make CIAs far more pervasive and far more burdensome.
He notes that these agreements are not mandated by Congress and are not part of any Health Care Financing Administration program initiative. "They are an invention of the OIG to expand its day-to-day control over providers in a way that is not provided by statute," Kendall argues.
Tom Jeffries, a health care attorney with the Seattle-based Davis, Wright Tremain, says it is clear from this release as well as earlier OIG guidance that the OIG is attempting to bootstrap items included in recent CIAs to older agreements. He also agrees that the OIG fails to provide any "bright lines" in terms of dollar amounts or other thresholds that would explain what constitutes a material violation, particularly for purposes of reporting an overpayment.
To view the OIG's entire document, go to www.dhhs.gov/progorg/oig/new.html.
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