On June 20, 2011, the Department of Health and Human Services Office of Inspector General (OIG) announced a new webpage dedicated solely to quality-of-care Corporate Integrity Agreements (CIAs). When a False Claims Act (FCA) settlement resolves allegations of fraud that involve the quality of patient care, the OIG may enter into a CIA with the provider. The OIG negotiates CIAs with health care providers as part of settlements of Federal health care program investigations arising under various civil false claims statutes. The providers agree to the obligations in the CIA, and the OIG agrees not to seek their exclusion from participation in Medicare, Medicaid or other Federal health care programs.
Specifically, a quality-of-care CIA requires the provider to retain an independent quality monitor who will address the specific issues alleged in the FCA action along with the provider’s overall ability to respond to patient care problems. When a provider enters into a quality-of-care CIA as part of a settlement, however, it is not an admission that it provided substandard patient care. In fact, the OIG website advises that the presence of a qualityof- care CIA is not indicative of the quality of care at the provider’s facility; nor is it a guarantee of adequate patient care going forward. As an example, with respect to nursing homes, the OIG website recommends that the public utilize the Centers for Medicare & Medicaid Services’ Nursing Home Compare Web site as a tool to obtain quality-of-care information about a specific facility.
The new webpage, located here, contains a central listing of all current quality-of-care CIAs that providers have entered into as part of FCA settlements. The website also provides links to press releases from the United States Attorney’s Office or the Department of Justice regarding these FCA settlements.
For more information on the FCA and quality-of-care in general, please click here for an article titled “Nursing Care Quality and the False Claims Act,” written by Jason E. Bring and Erin R. Kendall and published in the June edition of Long-Term Living magazine.