Feds use CIAs to enforce quality’ long-term care

Last week’s decision by Vencor, one of the nation’s largest operators of nursing homes and hospital services, to enter a five-year corporate integrity agreement (CIA) with the Department of Health and Human Services (HHS) Office of Inspector General (OIG) marks a new chapter in the government’s war against alleged substandard care in the long-term care industry.

The agreement, which was required as part of Louisville, KY-based Vencor’s Chapter 11 bankruptcy protection, puts an unprecedented focus on "quality" in the delivery of long-term care by requiring the company to adopt a comprehensive internal quality improvement program at the corporate, regional, and facility levels. The tentative deal resolves part of the government’s $2 billion claim against the company alleging poor quality of care and billing abuses.

In addition to creating a quality assurance "infrastructure," Vencor must engage a team of independent monitors selected by the OIG, create a comprehensive internal quality improvement program to review quality-related data, direct quality improvement activities, implement and monitor corrective action plans, and retain an independent review organization to evaluate the integrity and effectiveness of the company’s internal systems.

Health care attorney Joe Bianculli of Bianculli & Impink in Arlington, VA, says this agreement will not be the last of its kind. He points out that many long-term care companies are in bankruptcy and says the government has asserted a variety of financial claims against them. In order to resolve those claims, many of the companies must have their largest unsecured creditor, the federal government, at least acquiesce in the plan of discharge, he explains. But the government is not shy about its ability to use that leverage, warns Bianculli, who has represented several of these companies.

"There is no question that the OIG is making quality a significant part of corporate integrity agreements in long-term care and devoting a great deal of resources and attention to that issue," he asserts. "Nobody disputes that quality is a significant part of compliance in long-term care," he adds. "But the devil is in the details."