On December 14, 2021, the Office of Inspector General (OIG) posted an update to the Corporate Integrity Agreements FAQ on whether an entity that is subject to a Corporate Integrity Agreement (CIA) should disclose a Reportable Event, as defined below, through the CIA or through the OIG’s Self-Disclosure Protocol.
A CIA is a document that outlines the obligations to which an entity agrees as part of a civil settlement. An entity agrees to the CIA obligations in exchange for the OIG’s agreement that it will not seek to exclude the entity from participation in Medicare, Medicaid or other federal health care programs. CIAs require that the provider report all Reportable Events, generally within 30 days. The OIG defines a Reportable Event in its CIA by noting that it could be (1) a substantial overpayment; (2) a matter that a reasonable person would consider a probable violation of criminal, civil or administrative laws applicable to any federal health care program for which penalties or exclusion may be authorized; (3) the employment of or contracting with an ineligible person, as defined in the CIA; or (4) the filing of a bankruptcy petition.
The OIG’s Self Disclosure Protocol (Protocol) is available to facilitate the resolution of matters that, according to the disclosing party’s reasonable judgment, potentially violate federal criminal, civil or administrative laws for which OIG civil monetary penalties (CMPs) are authorized. The OIG’s general practice in resolving self-disclosures is to require a multiplier of 1.5 times the single damages amount and to require a minimum $100,000 settlement amount to resolve kickback-related submissions and a minimum $20,000 to resolve other matters.
According to the OIG’s FAQ:
“With respect to Reportable Events that implicate OIG’s CMP authorities, OIG will resolve such matters in a manner similar to disclosures submitted under the Protocol. In other words, a provider under a CIA may resolve its CMP liability associated with conduct that is disclosed as a Reportable Event without making a separate disclosure through the Protocol. The CIA monitor will work with the provider to resolve the matter consistent with the Protocol. In the event that a provider elects to make a disclosure both as a Reportable Event and to the Protocol, the provider must note in its submission to the Protocol that it is subject to a CIA and provide a copy of its Protocol submission to its OIG CIA monitor.”