Quality of Care Corporate Integrity Agreements

When a False Claims Act settlement resolves allegations of fraud that impact the quality of patient care, OIG may enter into a "quality-of-care" Corporate Integrity Agreement (CIA) with the settling provider. Under this type of CIA, OIG requires that the provider retain an independent quality monitor. The quality monitor not only will address the specific issues underlying the allegations, but also will look at the entity's delivery of care and evaluate the provider's ability to prevent, detect, and respond to patient care problems.

When a provider enters into a quality-of-care CIA as part of a settlement, it is not an admission that the provider provided substandard or worthless patient care. The presence of a quality-of-care CIA and a quality monitor, alone, is not determinative of the quality of care at the provider's facility or facilities. Nor does it guarantee that the provider will provide adequate patient care going forward.

For skilled nursing facilities and nursing facilities, the Centers for Medicare & Medicaid Services' Nursing Home Compare Web site is a useful tool to obtain quality-of-care information about a specific facility.

Below are links to the current CIAs that require an independent quality monitor. Where the quality-of-care CIA is with a provider that has multiple locations, an individual location may have had no involvement in the settlement. Also provided are links to press releases issued by the United States Attorney's Office or the Department of Justice about the related False Claims Act settlements.

http://oig.hhs.gov/compliance/corporate-integrity-agreements/quality-of-care.asp

Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.

To learn more about Atlantic Financial Consulting you may visit their website at

http://atlanticfinancial.us  or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.