A corporate integrity agreement (CIA) is a document outlining the obligations that a company involved in

health care in the United States The United States far outspends any other nation on health care, measured both in ''per capita'' spending and as a percentage of GDP. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The Uni ...

makes with a federal government agency or a state government as part of a civil settlement. On the federal level the Office of Inspector General of the Department of Health and Human Services and the

Department of Justice A justice ministry, ministry of justice, or department of justice is a ministry or other government agency in charge of the administration of justice. The ministry or department is often headed by a minister of justice (minister for justice in a v ...

are usually involved, and on the state level, the

state attorney general The state attorney general in each of the 50 U.S. states, of the federal district, or of any of the territories is the chief legal advisor to the state government and the state's chief law enforcement officer. In some states, the attorney genera ...

and the state offices involved in

Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...

or Medicare are involved. CIA can be used to address

quality of care Quality may refer to: Concepts *Quality (business), the ''non-inferiority'' or ''superiority'' of something * Quality (philosophy), an attribute or a property *Quality (physics), in response theory * Energy quality, used in various science discip ...

or corporate integrity issues. CIAs create a framework within which the company must operate in order to avoid being barred from participation in federal health care programs. States use CIAs as part of their anti-fraud efforts. CIAs generally last 5 years. During this time the provider is usually required to implement or expand a comprehensive employee training program, a confidential disclosure program, written standards and policies, and designate a compliance officer and committee if these things are not already done. CIAs also mandate establishing processes for managing and reporting “reportable events.” Reportable events include overpayments, ongoing investigations or legal proceedings, potential violation of criminal, civil, or administrative laws applicable to any Federal health care program for which penalties or exclusion may be authorized, and employing or contracting with an ineligible person. Some CIAs require an independent organization to review and monitor compliance with the terms and conditions of the CIA. Most CIAs require claims reviews to identify errors and their underlying causes. The government agency may check compliance through site visits. If a company breaks the agreement, the agency can fine them and if issues cannot be resolved the provider may be barred.

References

{{reflist American legal terminology Health law in the United States Medicare and Medicaid (United States)