Dental Entities Garner “High-Risk” Status from DHHS’ OIG

The Federal and Indiana State government recently announced that ImmediaDent of Indiana, LLC, and its administrative services provider, Samson Dental Partners, LLC, agreed to pay more than $5.1 million to settle allegations that they submitted false claims to Indiana’s Medicaid program. The parties agreed to the financial settlement without admitting any wrongdoing and notably, without entering into an Integrity Agreement (IA) and/or Corporate Integrity Agreement (CIA). 

The Department of Health and Human Services’ Office of Inspector General (OIG) negotiates IA/CIAs with health care providers and other entities as part of the settlement of Federal health care program investigations. A comprehensive agreement typically lasts five years and includes, among other things, requirements to:

  • Hire a compliance officer/appoint a compliance committee
  • Develop written standards and policies
  • Implement an employee training program
  • Retain an independent third party to conduct annual reviews
  • Report overpayments, reportable events, and ongoing investigations/legal proceedings
  • Report to OIG on the entity’s compliance activities

Providers or entities agree to the obligations detailed in their IA/CIAs, and in exchange, the OIG agrees not to seek their exclusion from Medicare, Medicaid, or other Federal health care programs. In effect, an IA/CIA demonstrates a party’s commitment to compliance and provides the OIG with a tool to swiftly enforce the party’s repeat offenses and/or violations of the IA/CIA. When a party agrees to a settlement, but declines to enter into an IA/CIA, the OIG considers that party to be deserving of heightened scrutiny because they are believed to pose a significant ongoing risk to Federal healthcare programs. As a consequence, the names of these “high-risk” individuals or entities are published on the OIG’s website. Conversely, the benefit of entering into an IA/CIA is to allow the provider a degree of clarity as to what behaviors the OIG will consider problematic, and further defines the accountability expected of the provider by the OIG. Typically, it is advisable to negotiate a IA/CIA that is reasonable for both the provider and the OIG.

Frier Levitt regularly counsels professional licensees and healthcare entities with regard to OIG investigations, settlements and IA/CIAs. Contact Frier Levitt today to speak with an attorney.