ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric Services of America (PSA) made the wrong kind of history by becoming the first provider to settle claims for violating the overpayment rules. In addition to a $6.88 million fine, PSA had to enter into a requiring it to enter into a corporate integrity agreement (CIA) And now the OIG has fined PSA $22,500 for not meeting its compliance obligations under the CIA, specifically:

  • Not having its Chief Compliance Officer make a quarterly report directly to the Board of Directors in the first quarter of 2017.
  • Not ensuring that the Compliance Committee met at least once a quarter during 2017.

Significance: The CIA is something like healthcare enforcement’s version of the scarlet letter, a penalty whose legacy seems to continue perpetually after the transgression that prompted it. Providers that enter into a CIA as part of a settlement are compelled to take draconian compliance measures for a number of years and subject to review and pre-determined fines for not implementing those measures. The PSA case is the latest example of just how onerous the CIA can be.

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