Medicare Compliance & Reimbursement

Question: I’m new to the front desk of a medical practice and heard a colleague mention the “CIA” in regards to some kind of agreement. I don’t feel comfortable asking yet, but is there a branch of the Central Intelligence Agency that is dedicated to healthcare? Do they normally investigate medical practices?

Pennsylvania Subscriber

Answer: You don’t provide enough information to determine whether your colleague was discussing the Central Intelligence Agency, the Culinary Institute of America, or a corporate integrity agreement, all of which are commonly known by the acronym “CIA.” However, in terms of a healthcare setting, the latter is most likely. The Office of Inspector General (OIG) issues these agreements with entities so as not to exclude them from participation in Medicare, Medicaid, or other federal health programs.

In case you’re curious about what exactly a CIA entails, the OIG says, on its website: “CIAs have common elements, but each one is tailored to address the specific facts of the case and may incorporate elements of a preexisting compliance program. An integrity agreement (IA) is a document that outlines the obligations to which an individual practitioner, small group practice, or small provider agree as part of a civil settlement.”

The OIG website has more information on entities that are excluded, enforcement actions, and other relevant information for noncompliant entities, if you want to have a look around and see whether you can find more information about your workplace.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC