As compliance professionals, many of us are acutely aware of the published Corporate Integrity Agreements (CIA) that the OIG publishes on their website. We read and study these documents because it gives us a glimpse of how the OIG thinks compliance programs should be organized and run.
Providers who sign CIAs usually do it to avoid further enforcement or exclusion from government health programs like Medicare and Medicaid. Many of us stop reading the CIA at the point where it discusses penalties for not meeting the requirements of the CIA. We may think, “if an organization is to the point where a CIA is required, they definitely would violate the provisions of the CIA.”
But alas, there are times when the OIG must penalize the organizations even further for violations of the terms of the CIA. Let’s look at some examples from the last sixteen months:
02-04-2019--Nursing Home Facility Operator Pays CIA Stipulated Penalty
On February 4, 2019, Cornerstone Healthcare Services, LLC (Cornerstone) paid a stipulated penalty of $22,500 for failing to pay two invoices received from the Quality Monitor in accordance with the requirements of its CIA with OIG.
11-29-2018--Nursing Home Facility Operator Pays CIA Stipulated Penalty
On November 29, 2018, Cornerstone Healthcare Services, LLC (Cornerstone) paid a stipulated penalty of $15,000 for Cornerstone's failure to have its Compliance Officer make a quarterly report directly to Cornerstone's Governing Body during the first two calendar quarters of 2018.
11-19-2018--Independent Diagnostic Testing Facility Company and Owner Pay CIA Stipulated Penalty
On November 19, 2018, OSD Management, LLC and Fuad Rehman Cochinwala paid a stipulated penalty of $35,000 for failure to screen their Covered Persons in accordance with the requirements of their CIA with OIG.
10-26-2018--Pediatric Home Health Company Pays CIA Stipulated Penalty
On October 26, 2018, Pediatric Services of America, Inc. (PSA), paid a stipulated penalty of $22,500 for PSA's failure to establish and implement the obligations relating to having a Compliance Officer and a Compliance Committee. Specifically, PSA did not have its Chief Compliance Officer make a quarterly report directly to the Board of Directors during the first quarter of 2017. PSA also did not ensure that the Compliance Committee met at least quarterly during 2017.
09-14-2018--OIG Excludes Oklahoma Prosthetics Supplier for Material Breach
On September 14, 2018, OIG excluded La Fuente Ocular Prosthetics, LLC (La Fuente), for a period of five years based on a material breach of its Corporate Integrity Agreement (CIA). OIG determined La Fuente to be in material breach of its CIA when La Fuente failed to repay an overpayment identified by its Independent Review Organization in La Fuente's second annual reporting period. OIG issued a notice of material breach and intent to exclude on July 10, 2018. On August 14, 2018, OIG sent La Fuente an exclusion letter. Under the terms of the CIA, La Fuente had 25 days to request a hearing with an Administrative Law Judge. La Fuente did not request a hearing, and the exclusion went into effect on September 14, 2018.
07-18-2018--Electronic Health Records Software Company Pays CIA Stipulated Penalty
On July 18, 2018, eClinical Works, LLC paid a stipulated penalty of $132,500 for failure to comply with its obligation to timely report Patient Safety Issues as Reportable Events, as required by its CIA with the OIG.
12-21-2017--Connecticut Dentist and Practice Pay IA Stipulated Penalty
On December 21, 2017, Jesus Villegas, D.D.S., Fairfield Pediatric Dentistry, LLC, and Haven Pediatric Dentistry, LLC (collectively, Dr. Villegas), agreed to pay $12,000 for his failure to screen Covered Persons against the OIG exclusion list.
10-31-2017--New York Physician and Practice Pay IA Stipulated Penalty
On October 31, 2017, Dr. Feng Qin, M.D. and Qin Medical PC (collectively, Dr. Qin) paid a $12,000 stipulated penalty for his failure to screen Covered Persons against the OIG and GSA exclusion lists.
These examples should demonstrate to all of us that even after a significant event such as the implementation of a CIA, organizations still need to focus on their compliance programs and especially the terms of their CIA if they are subject to one. We can all learn from these examples by taking the lessons to heart.
CJ Wolf
Questions or Comments?