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Corporate Integrity Agreements

Every year, the American healthcare and life sciences industries lose billions of dollars to fraud and abuse. Instances of fraud range from performing medically unnecessary procedures for insurance gains, to billing for services not rendered, to illegally altering patient information, to accepting kickbacks for patient referrals, to unlawfully promoting drugs. Such incidents not only drain the economy, but they also pose a hazard to patient health and safety. For instance, patients whose medical information has been unlawfully altered may receive the wrong treatment or realize that their health insurance benefits have been exhausted.

To keep these risks in check, the US government and regulators have been cracking the whip down on healthcare and pharmaceutical organizations by enforcing regulations such as HIPAA/HITECH and FDA, as well as audits such as RAC audits. Organizations that do not comply or display any sign of fraud pay heavy penalties. In a worst-case scenario, they could be barred from participating in Medicare, Medicaid and other Federal healthcare programs. The resultant losses would be tremendous, as Medicare and Medicaid patients usually bring in significant revenues.

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MetricStream Corporate Integrity Agreement Management Software Solution

Fortunately, organizations have a second chance at redeeming themselves through Corporate Integrity Agreements (CIAs). These agreements are usually part of negotiated settlements with the Office of Inspector General (OIG). They enable organizations to avoid exclusion from Medicare or Medicaid programs by establishing and demonstrating a robust compliance framework, as per CIA stipulations.

MetricStream offers an advanced, comprehensive system to efficiently manage all aspects of CIA compliance, ranging from risk assessments, to control testing and monitoring, to audit lifecycle management, to issue remediation, to reporting, to training. The system also enables comprehensive compliance with all other regulations including FDA, HIPAA/HITECH, CMS mandates and the Affordable Care Act.

Built on a single platform, the MetricStream solution can be extended across the enterprise for seamless coordination of CIA compliance processes and audits. The solution is packed with powerful capabilities such as risk heat maps, regulatory tracking alerts, automated issue remediation workflows, a centralized document repository, executive dashboards and embedded best practices. All these features come together to empower organizations to meet the demands of CIA and other compliance regulations with ease and efficiency.

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