Health Care Administration Corporate Integrity Agreement

Question :

What measures required by the Corporate Integrity Agreement do you believe will be most effective in preventing future violations? Which, if any, do you think will be least effective or ineffective in preventing future Anti-kickback violations? Explain your reasoning.

Answer :

What measures required by the Corporate Integrity Agreement do you believe will be 

The Board of Commissioners Compliance Obligations are the most effective measure for preventing future Anti-kickback violations. The most important reason for its effectiveness is the inclusion of independent members. The board would be responsible for inquiry of the actions of Halifax and its compliance performance would be reviewed bimonthly. It is a comprehensive approach because it also includes the review of Compliance Officer and Compliance Committee. Also, in case of any changes that can affect the Board, Halifax must report the changes to OIG within a short timeframe of 5 days (Halifax Hospital Medical Center , 2014). The Code of Conduct would be the least effective measure because it is not always possible to evaluate whether the compliance to the Code is maintained. Although the requirement is that it should be distributed to all medical staff and the records for certification submission is maintained but the compliance post submission in everyday services cannot be strictly reviewed.  However, having a Code of Conduct is necessary as a foundation of compliance. 

Office of Inspector General (OIG) issued a Special Advisory Bulletin on Joint Ventures for entering into joint ventures with physicians (Office of Inspector General, 2003). According to this Bulletin a social insurance provider enters into a contract with administration supplier to serve the provider’s current patient base. The Provider creates a related line of business which is presented to the possible contender. It declares that Provider's share of the profits from joint venture includes Medicare/Medicaid patients’ referral remuneration and can violate the federal Anti-kickback Statute. A potentially problematic contractual agreement can constitute new line of business, hostage referral base and absence of business risks. Problems can arise in these cases when the operations are arranged or provided by the supplier butt the billing is done under provider’s name. The Bulletin is not restrictive enough because it does not address all kinds of suspected attributes and levels of risk. Therefore, it is not possible to determine what level of involvement is appropriate to avoid the risk of being a suspect (Callender, Hastings, Hemsley, Morris, & Peregrine, 2003). 

The resources available to CMS to handle waste management and fraud in the Medicaid program needed an expansion which was addressed by the Medicaid Integrity Plan. This Act or Plan was created by CMS and it is responsible for maintaining it as well. This Plan covers the responsibility to hire contractors who would review the services and activities, audits and overpayments of Medicaid Provider (CMS, 2008). These contractors would also spread awareness about Medicaid integrity problems. The next responsibility is to assist state in preventing and handling Medicaid provider abuse and fraud cases. Lastly, it covers the responsibility to eliminate the problem of improper payments and recovery of the same.