Department of Health and Human Services: Office of Inspector General's Use of Agreements to Protect the Integrity of Federal Health Care Programs, Report to Congressional Requesters   [open pdf - 545KB]

"HHS-OIG [Department of Health and Human Services' Office of Inspector General] has the authority to exclude providers and other entities that have committed certain acts, such as submitting false or fraudulent claims, from participation in federal health care programs. However, HHS-OIG can enter into agreements--CIAs [Corporate Integrity Agreements] and IAs [Integrity Agreements]--with providers and other entities as an alternative to exclusion. HHS-OIG is responsible for negotiating such agreements--which it typically does at the same time the Department of Justice [DOJ] is negotiating a legal settlement to resolve related allegations--and then monitoring the entities' compliance with them. GAO [Government Accountability Office] was asked to review HHS-OIG's use of these agreements. This report describes (1) the number of agreements and their general characteristics; (2) the circumstances that may lead to an agreement and the standard provisions of agreements; and (3) monitoring efforts and actions taken, if any, in response to noncompliance with the agreements. GAO examined agreements entered into from July 2005 (when HHS-OIG created its database) through July 2017 (most current at the time of GAO's analyses) and used HHS-OIG data to describe agreements' characteristics and actions to address noncompliance. GAO reviewed HHS-OIG documentation, including agreement templates and a selection of agreements to identify standard provisions. GAO also interviewed HHS-OIG and DOJ officials. GAO provided a draft of this report to HHS and DOJ. The agencies provided technical comments, which were incorporated as appropriate."

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Government Accountability Office: http://www.gao.gov/
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