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CPMA terms, Exam sections Coverage, rated A+
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CPMA terms, Exam sections Coverage, rated A+ Certificate of compliance agreement - -Require the provider to certify that it will continue to operate its existing compliance programs and to report to OIG for a lesser period of time (usually 3 years) Corporate integrity agreements - -A condit...

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  • February 16, 2023
  • 3
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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  • cpma terms
  • exam sections coverage
  • rated a certificate of compliance agreement require the provider to certify that it will continue to operate its existing compliance programs and to report to

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  • CPMA
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CPMA terms, Exam sections Coverage,
rated A+

Certificate of compliance agreement - ✔✔-Require the provider to certify that it will continue to operate
its existing compliance programs and to report to OIG for a lesser period of time (usually 3 years)



Corporate integrity agreements - ✔✔-A condition of not seeking exclusion from participation when an
entity seeks to settle CIVIL health care fraud cases. Typically last 5 years.



Circumstances that the OIG would consider relative to CIA:



1. Whether the provider self disclosed alleged conduct;

2. The monetary damage to federal healthcare programs;

3. Whether the case involves succesor liability;

4. Whether the provider is still participating in the federal healthcare programs or in the line of business
that gave rise to the fraudulent conduct;

5. Whether the alleged conduct is capable of repetition;

6. The age ofthe conduct;

7. Whether the provider has an effective compliance program and would agree to limited compliance or
integrity measures and would ANUALLY certify such compliance to the OIG; and

8. Other circumstances, as appropriate.



Independent review organization - ✔✔-Acts as 3rd party medical review source that provides objective,
unbiased audits and reports. Hired by tge auditee's legal counsel working on behalf of the OIG.



Fraud - ✔✔-Making false statements or misrepresenting facts to obtain undeserved payment or benefit
from a federal health care program.

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