In this case, Friendship Home Health Inc. et al. and its owner Theophilus Egbujor paid US$6.5 million, plus interest, to clarify allegations that they improperly charged TennCare, Medicare and TRICARE for home health services, according to a press release. As part of the Agreement reached in June 2015, Friendship and its owner also agreed to be linked by a CIA`s terms and conditions with HHS-OIG in order to avoid future fraud and compliance failures. A health organization may ask to be heard by an HHS administrative judge to challenge the OIG`s finding of non-compliance, resulting in a sanction or exclusion. However, following numerous enforcement actions taken by the Authority for breach of CIA conditions, it is clear that the OIG does not hesitate to use its authority to enforce business integration agreements. The annual report will keep the OIG informed of the supplier`s compliance activities for the duration of the agreement. It includes health compliance activities and the results of the IRO audit of the organization`s compliance with the provisions of the OIG Corporate Integrity Agreement. The annual report contains, among other things, a description of all audits, audits or analyses of the Organization`s compliance program, the Organization`s response to such audits, audits or analyses, and a summary report on any overpayments made during the period. In addition, an official must certify that the organization is complying with its obligations under the CIA IGO`s corporate integrity provisions.
The amount of the sentence imposed and its support by the administrative courts send a message about the seriousness with which OIG is taking the CIA, Waltz said. “OIG really expects you to meet all your obligations,” she noted. If you are under the control of the CIA, it is also essential to have confidence in the competence of your IRO to verify claims. The ALJ and ATM are not there to verify, or even verify, the accuracy of the IRO`s overpayment provision, or even the accuracy of the prescribed sanction, Waltz said. Friendship had appealed the sentence imposed in 2018 on an administrative judge (ALJ) who upheld it in October 2019. The public health company appealed the ALJ decision to the ATM and lost. Although this decision is not yet available online, the OIG stated that the ATM agreed with the ALJ decision, which stated: “The SdI had a contractual right to charge specific penalties because the petitioners violated the CIA by not repaying the overpayments identified by the IRO.” OIG negotiates business integrity agreements as a result of comparisons arising from studies of the state public health program, which result from a large number of improper civil law requirements laws.