Why corporate integrity agreements aren't a magic bullet

Corporate integrity agreements are often part of the deal when the Office of Inspector General settles false claims cases with providers and organizations. Entities agree to the terms of these agreements, and the government agrees not to exclude them (at least at that time) from participation in federal programs.

Corporate integrity agreements usually require providers and organizations to run in-house compliance programs. One reason for this is that if companies understand the requirements of government business, and if they create a culture of openness where problems are quickly identified, reported and addressed, then fraud is less likely to gain a foothold within their walls.  

But do corporate integrity agreements really deter healthcare fraud? Do companies that make these agreements change for the better? Results have been mixed. Maybe success depends on receptiveness to what the agreements are trying to achieve.    

Subsequent problems argue against the fraud prevention value of these agreements. CareAll Management for example, one of Tennessee's largest home healthcare providers, recently resolved its second false claims case. Furthermore, what about companies that settle additional False Claims cases while they're subject to active corporate integrity agreements? Either these organizations keep stumbling over the requirements of government business, or the spirit of the agreements hasn't moved them off agendas incompatible with integrity.

It's easy to make mistakes while working in federally funded programs, and the likelihood of mistakes grows with every delegated organization involved in the job. It's also possible for employees with no ill intent to take actions regulators view as false claims, as Blue Cross and Blue Shield of Louisiana's Darrell Langlois told FierceHealthPayer: AntiFraud in an exclusive interview.

Meeting the demands of a corporate integrity agreement can build a compliance infrastructure, but that doesn't guarantee ethical behavior or make a company fraud-proof. Setting up a compliance program is just the beginning.

It's easy to write a code of conduct full of high-minded words, for example; even Enron did that. But codes of conduct have no value unless they influence behavior.

And a troubled company can hire a compliance officer; but compliance officers have become whistleblowers after executives refused to correct reported wrongs.

Companies can also train employees in compliance and ethics; but if staff experience the training as a pain-in-the-neck task to cross off a list, then the programs miss their mark. One insurer, for example, offered a rigorous Medicare e-training along with a test staff needed to pass at a designated proficiency level. But an employee printed the screens, circled the correct answers to the test and gave them to a thankful workgroup. The best laid compliance plans can be foiled if their purpose doesn't resonate with people.    

The bottom line is this: Integrity can't be externally imposed. It flows from substance, not outer forms.

To deter fraud, corporate integrity agreements must help people and organizations connect with an inner core of integrity. And that must drive business decisions at all levels--not just when it's easy or convenient or good for public relations, but when the costs are high and the stakes are great. Compliance and ethics must become, as one payer CEO put it, part of the corporate DNA. Then we may see less fraud. - Jane (@HealthPayer)

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