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March 24, 2016

Nursing Home Chain Executes CIAs with OMIG

The New York State Office of the Medicaid Inspector General (“OMIG”) recently imposed six Corporate Integrity Agreements (“CIAs”) on a chain of nursing homes located in the Mid-Hudson Valley. This marks the first time a nursing home has been the subject of an OMIG CIA.

OMIG imposes a CIA on a provider often when it determines that the provider has committed unacceptable practices, but the provider’s removal from the Medicaid program would negatively impact access to necessary services. The CIA allows for strict oversight of a provider. Providers under a CIA are subjected to monitoring that includes, but is not limited to, annual claims reviews, cost reporting reviews, and compliance program reviews.

In this case, the term of each CIA is five years and requires that the nursing home engage an Independent Review Organization (“IRO”) that OMIG must approve for purposes of conducting certain compliance reviews and audits with periodic reporting back to OMIG. The CIA sets out specific terms relating to each entity’s corporate compliance program and reporting.

Prior CIAs that OMIG had imposed had expired. In those CIAs, each contained a reference in the preamble to a simultaneous stipulation with the New York State Attorney General Medicaid Fraud Control Unit relating to the conduct leading to the imposition of the CIA. The CIAs with the Nursing Home chain do not reference any simultaneous MFCU stipulation in the preamble. Only one other CIA does not reference a MFCU stipulation.


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