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 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 [Show More]

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