CORPORATE INTEGRITY AGREEMENT
Exhibit
10.2
BETWEEN
THE
OFFICE
OF INSPECTOR GENERAL
OF
THE
DEPARTMENT
OF HEALTH AND HUMAN
SERVICES
AND
MAXIMUS,
INC.
I. PREAMBLE
Maximus,
Inc., on behalf of the Maximus Consulting Segment, hereby enters into this
Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG)
of the United States Department of Health and Human Services (HHS) to promote
compliance with the statutes, regulations, and written directives of Medicare,
Medicaid, and all other Federal health care programs (as defined in 42 U.S.C.
§
1320a-7b(f)) (Federal health care program requirements). Contemporaneously
with
this CIA, Maximus is entering into a Settlement Agreement with the United
States.
II. TERM
AND SCOPE
OF THE
CIA
A. The
period of the compliance obligations assumed by Maximus under this CIA shall
be
five years from the effective date of this CIA, unless otherwise specified.
The
effective date shall be the date on which the final signatory of this CIA
executes this CIA (Effective Date). Each one-year period, beginning with the
one-year period following the Effective Date, shall be referred to as a
“Reporting Period.”
B. Sections
VII, IX, X, and XI shall expire no later than 120 days after OIG’s receipt of:
(1) Maximus’ final annual report; or (2) any additional materials submitted by
Maximus pursuant to OIG’s request, whichever is later.
C. The
scope
of this CIA shall be governed by the following definitions:
1.
“Covered Persons” includes:
a. all
officers, directors, and employees of Maximus; and
b. all
contractors, subcontractors, agents, and other persons who perform work under
a
contract that relates to maximizing Federal health care program reimbursement
and/or who perform claiming functions relating to Federal health care
programs;
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Notwithstanding
the above, this term does not include part-time or per diem employees,
contractors, subcontractors, agents, and other persons who are not reasonably
expected to work more than 160 hours per year, except that any such individuals
shall become “Covered Persons” at the point when they work more than 160 hours
during the calendar year.
2.
“Relevant Covered Persons” includes Covered Persons involved in work performed
under a contract that related to maximizing Federal health care program
reimbursement and/or in the preparation or submission of claims for
reimbursement from any Federal health program care program.
III.
CORPORATE
INTEGRITY
OBLIGATIONS
Maximus
shall revise and enhance its existing Compliance Program such that it includes
the following elements:
A.
Compliance Officer and Committee.
1.
Compliance
Officer.
Within
90 days after
the Effective Date, Maximus shall appoint an individual to serve as its
Compliance Officer and shall maintain a Compliance Officer for the term of
the
CIA. The Compliance Officer shall be responsible
for developing and implementing policies, procedures, and practices designed
to
ensure compliance with the requirements set forth in this CIA and with Federal
health care program requirements. The Compliance Officer shall be a member
of
senior management of Maximus, shall make periodic (at least quarterly) reports
regarding compliance matters directly to the Board of Directors of Maximus,
and
shall be authorized to report on such matters to the Board of Directors at
any
time. The Compliance Officer shall not be or be subordinate to the General
Counsel or Chief Financial Officer. The Compliance Officer shall be responsible
for monitoring the day-to-day compliance activities engaged in by Maximus as
well as for any reporting obligations created under this CIA.
Maximus
shall report to OIG, in writing, any changes in the identity or position
description of the Compliance Officer, or any actions or changes that would
affect the Compliance Officer’s ability to perform the duties necessary to meet
the obligations in this CIA, within 15 days after such a change.
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2.
Compliance
Committee.
Within 90 days after the Effective Date, Maximus shall appoint
a
Compliance Committee. The Compliance Committee shall, at a minimum, include
the
Compliance Officer and other members of senior management necessary to meet
the
requirements of this CIA (e.g., senior executives with relevant
responsibilities such as quality assurance, contract management and oversight,
audit, and operations). The Compliance Officer shall chair the Compliance
Committee and the Committee shall support the Compliance Officer in fulfilling
his/her responsibilities (e.g., shall assist in the analysis of the
organization’s risk areas and shall oversee monitoring of internal and external
audits and investigations).
Maximus
shall report to OIG, in writing, any changes in the composition of the
Compliance Committee, or any actions or changes that would affect the Compliance
Committee’s ability to perform the duties necessary to meet the obligations in
this CIA, within 15 days after such a change.
B.
Written Standards.
1.
Code
of Conduct. Within
90 days after the Effective Date, Maximus shall develop, implement, and
distribute a written Code of Conduct to all Relevant Covered Persons. The Code
will be distributed to all other Covered Persons within 150 days of the
Effective Date. Maximus shall make the promotion of, and adherence to, the
Code
of Conduct an element in evaluating the performance of all employees. The Code
of Conduct shall, at a minimum, set forth:
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a.
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Maximus’
commitment to full compliance with all Federal health care program
requirements, including its commitment to fulfill all of its contractual
obligations and prepare and submit accurate claims in manner that
is
consistent with such requirements;
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b.
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Maximus’
commitment to adhere to professional and ethical standards of conduct
for
consultants;
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c.
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Maximus’
requirement that all of its Covered Persons shall be expected to
comply
with all Federal health care program requirements and with Maximus’ own
Policies and Procedures as implemented pursuant to Section III.B
(including the requirements of this
CIA);
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d.
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the
requirement that all of Maximus’ Covered Persons shall be expected to
report to the Compliance Officer, or other appropriate individual
designated by Maximus, suspected violations of any Federal health
care
program requirements or of Maximus’ own Policies and
Procedures;
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e.
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the
possible consequences to both Maximus and Covered Persons of failure
to
comply with Federal health care program requirements and with Maximus’ own
Policies and Procedures and the failure to report such noncompliance;
and
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f.
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the
right of all individuals to use the Disclosure Program described
in
Section III.E, and Maximus’ commitment to nonretaliation and to maintain,
as appropriate, confidentiality and anonymity with respect to such
disclosures.
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Within
90
days after the Effective Date, each Relevant Covered Person shall certify,
in
writing, that he or she has received, read, understood, and shall abide by
Maximus’ Code of Conduct. Within 150 days after the Effective Date, all other
Covered Persons shall certify, in writing, that he or she has received, read,
understood, and shall abide by Maximus’ Code of Conduct. New Covered Persons
shall receive the Code of Conduct and shall complete the required certification
within 90 days after becoming a Covered Person or within 150 days after the
Effective Date, whichever is later. New Relevant Covered Persons shall receive
the Code of Conduct and shall complete the required certification within 30
days
after becoming a Relevant Covered Person or within 90 days after the Effective
Date, whichever is later.
Maximus
shall periodically review the Code of Conduct to determine if revisions are
appropriate and shall make any necessary revisions based on such review. Any
revised Code of Conduct shall be distributed within 30 days after any revisions
are finalized. Each Covered Person shall certify, in writing, that he or she
has
received, read, understood, and shall abide by the revised Code of Conduct
within 30 days after the distribution of the revised Code of
Conduct.
2.
Policies
and Procedures.
Within 90 days after the Effective Date, Maximus shall implement
written Policies and Procedures regarding the operation of Maximus’ compliance
program and its compliance with Federal health care program requirements. At
a
minimum, the Policies and Procedures shall address:
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a.
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the
subjects relating to the Code of Conduct identified in Section
III.B.1;
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b.
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measures
to ensure that Maximus employees document in writing all recommendations
and steps taken to maximize Federal health care
reimbursement;
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c.
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measures
to ensure that quality assurance reviews are performed prior to
submissions of recommendations for maximizing Federal health care
program
reimbursement;
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d.
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measures
to ensure that all Covered Persons engaged in the preparation and/or
submission of claims are trained on the requirements of the relevant
state
and Federal health care programs;
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e.
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measures
to ensure that Maximus has adequate quality assurance oversight of
any
Covered Person engaged in the preparation and/or submission of claims
to
any Federal health care programs;
and
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f.
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measures
designed to meet the requirements of Section 6032 of the Deficit
Reduction
Act.
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Within
90
days after the Effective Date, the relevant portions of the Policies and
Procedures shall be distributed to all individuals whose job functions relate
to
those Policies and Procedures. Appropriate and knowledgeable staff shall be
available to explain the Policies and Procedures.
At
least
annually (and more frequently, if appropriate), Maximus shall assess and update,
as necessary, the Policies and Procedures. Within 30 days after the effective
date of any revisions, the relevant portions of any such revised Policies and
Procedures shall be distributed to all individuals whose job functions relate
to
those Policies and Procedures.
C.
Training and Education.
1.
General
Training.
Maximus shall provide at least two hours of General Training to
each
Relevant Covered Person within 90 days after the Effective Date.
Maximus shall provide at least one hour of General Training to other Covered
Person within 150 days of the Effective Date This training, at a minimum, shall
explain Maximus’:
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a.
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CIA
requirements; and
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b.
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Maximus’
Compliance Program (including the Code of Conduct and the Policies
and
Procedures as they pertain to general compliance
issues).
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New
Covered Persons shall receive the General Training described above within 30
days after becoming a Covered Person or within 90 days after the Effective
Date,
whichever is later. After receiving the initial General Training described
above, each Covered Person shall receive at least one hour of General Training
in each subsequent Reporting Period.
2.
Specific
Training.
Within 90 days after the Effective Date, each Relevant Covered
Person shall receive at least four hours of Specific Training in addition to
the
General Training required above. Up to two hours of training with respect to
quality assurance and contract oversight procedures conducted on or after
January 1, 2007 through and including the CIA Effective date can count toward
this training requirement. This Specific Training shall include a discussion
of:
a.
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Maximus’
policies and procedures about quality
assurance;
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b.
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Maximus’
consulting contract oversight
requirements;
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c.
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Maximus’
commitment to adhere to professional and ethical standards of conduct
for
consultants;
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d.
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the
Federal health care program requirements regarding the accurate coding
and
submission of claims;
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e.
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policies,
procedures, and other requirements applicable to the documentation
requirements;
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f.
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the
personal obligation of each individual involved in the claims submission
process to ensure that such claims are
accurate;
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g.
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applicable
reimbursement statutes, regulations, and program requirements and
directives;
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h.
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the
legal sanctions for violations of the Federal health care program
requirements; and
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i.
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examples
of proper and improper claims submission
practices.
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New
Relevant Covered Persons shall receive this training within 60 days after the
beginning of their employment or becoming Relevant Covered Persons, or within
90
days after the Effective Date, whichever is later. A Maximus employee who has
completed the Specific Training shall review a new Relevant Covered Person’s
work, to the extent that the work relates to the delivery of patient care items
or services and/or the preparation or submission of claims for reimbursement
from any Federal health care program, until such time as the new Relevant
Covered Person completes his or her Specific Training.
After
receiving the initial Specific Training described in this Section, each Relevant
Covered Person shall receive at least 3 hours of Specific Training in each
subsequent Reporting Period.
3. Certification.
Each individual who is required to attend training shall certify, in
writing, or in electronic form, if applicable, that he or she has received
the
required training. The certification shall specify the type of training received
and the date received. The Compliance Officer (or designee) shall retain the
certifications, along with all course materials. These shall be made available
to OIG, upon request.
4. Qualifications
of Trainer. Persons providing the training shall be knowledgeable about the
subject area.
5. Update
of Training. Maximus shall review the training annually, and, where
appropriate, update the training to reflect changes in Federal health care
program requirements, any issues discovered during internal audits or the
Consulting Contract Review and any other relevant information.
6. Computer-based
Training. Maximus may provide the training required under this CIA through
appropriate computer-based training approaches. If Maximus chooses to provide
computer-based training, it shall make available appropriately qualified
and knowledgeable staff or trainers to answer questions or provide additional
information to the individuals receiving such training.
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D.
Review Procedures.
1. General
Description.
a. OIG
Office of Audit Services (OAS). The OIG Office of Audit Services (OAS)
shall perform a Consultant Contract Review and Claims Review. Maximus will
reimburse OAS at the applicable annual hourly reimbursement rate (e.g. for
FY
2007 that rate is $100.41). Maximus will pay all OAS invoices within 30 days
of
the receipt of an invoice.
b. Frequency
of Claims Review. The Claims Review shall be performed annually and shall
cover each of the Reporting Periods. The OAS shall perform all components of
each annual Claims Review.
c. Retention
of Records. OAS and Maximus shall retain and make available to the Office
of Counsel to the Inspector General (OCIG), upon request, all work papers,
supporting documentation, correspondence, and draft reports related to the
reviews.
2. Consulting
Con tract Review. The Consulting Contract Review shall include a Contract
Compliance Review and a Claims Review.
a.
Contract Compliance Review. Within 60 days of the end of the first
Reporting Period, Maximus will provide OAS with a list of all consulting
contracts or financial arrangements that relate in any way to Federal health
care programs under which Maximus worked during the Reporting Period. For
each
contract or financial relationship, Maximus will identify: (1) the date of
the
contract or task order; (2) the parties to the contract or arrangement
(“Client(s)”); (3) a brief description of the scope of work; (4) whether Maximus
was paid on a contingency fee basis during the reporting period; (5) whether
Maximus prepared and/or submitted claims for reimbursement under any Federal
health care program under the contract; (6) the total amount of Maximus’
revenues based on the contract.
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x.
XXX
shall select a sample of 10% (or a minimum of 5 and a maximum of 15) of the
contracts that involve or relate to claiming under federal healthcare programs
to review (“Sample Contracts”). OAS shall also ensure that no more than one
Sample Contract involves or relates to audit preparation services.
c. For
each of the Sample Contracts, OAS shall:
1.
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Review
terms of the contract (i.e. number of Federal revenue maximization
initiatives included);
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2.
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Review
the criteria for the Federal program(s) involved;
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3.
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Obtain
the methodology used to determine the costs claimed;
and
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4.
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Determine
if the methodology is in accordance with Federal and State
requirements.
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3.
Claims
Review. OAS shall
select minimum of 3 and a maximum 10 Sample Contracts on which to perform a
Claims Review as follows:
a.
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For
each of the Sample Claim Contracts, OAS shall randomly select and
review a
sample of 50 claims submitted by
Maximus;
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x.
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XXX
shall determine whether the claims were correctly coded, submitted,
and
reimbursed based on review of supporting
documentation.
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c.
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Systems
Review. If
Maximus’ Claims Review identifies an
Error
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Rate
of 5%
or greater, OAS shall also conduct a Systems Review. Specifically, for each
claim in the Claims Review that resulted in an Overpayment, OAS shall perform
a
“walk through” of the system(s) and process(es), that generated the claim to
identify any problems or weaknesses that may have resulted in the identified
Overpayments. OAS shall provide its observations and recommendations on
suggested improvements to the system(s) and the process(es) that generated
the
claim.
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4. Notification
to Parties Affected by Results of Consulting Con tract Review. In
accordance with Section III.H. 1, Maximus shall notify in writing within 30
days
the Client and the appropriate representative of the relevant state and/or
federal health care program affected by the results of the Consulting Contract
Review. If the Client is affected by the results of the claims review, Maximus’
notification will include a quantification of the potential overpayment. Maximus
shall make available to OIG all documentation that reflects Maximus compliance
with this section. Nothing in this Agreement will affect any rights of any
Client of Maximus to review and appeal with the affected federal health care
program any potential overpayment identified by the OAS audit.
5. Claims
Review Report. OAS shall prepare a report based upon the Consulting
Contract Review.
E.
Disclosure Program.
Within
90
days after the Effective Date, Maximus shall establish a Disclosure Program
that
includes a mechanism (e.g., a toll-free compliance telephone line) to
enable individuals to disclose, to the Compliance Officer or some other person
who is not in the disclosing individual’s chain of command, any identified
issues or questions associated with Maximus’ policies, conduct, practices, or
procedures with respect to a Federal health care program believed by the
individual to be a potential violation of criminal, civil, or administrative
law. Maximus shall appropriately publicize the existence of the disclosure
mechanism (e.g., via periodic e-mails to employees or by posting the
information in prominent common areas).
The
Disclosure Program shall emphasize a nonretribution, nonretaliation policy,
and
shall include a reporting mechanism for anonymous communications for which
appropriate confidentiality shall be maintained. Upon receipt of a disclosure,
the Compliance Officer (or designee) shall gather all relevant information
from
the disclosing individual. The Compliance Officer (or designee) shall make
a
preliminary, good faith inquiry into the allegations set forth in every
disclosure to ensure that he or she has obtained all of the information
necessary to determine whether a further review should be conducted. For any
disclosure that is sufficiently specific so that it reasonably: (1) permits
a determination of the appropriateness of the alleged improper practice; and
(2)
provides an opportunity for taking corrective action, Maximus shall conduct
an
internal
review of the allegations set forth in the disclosure and ensure that proper
follow-up is conducted.
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The
Compliance Officer (or designee) shall maintain a disclosure log, which shall
include a record and summary of each disclosure received (whether anonymous
or
not), the status of the respective internal reviews, and any corrective action
taken in response to the internal reviews. The disclosure log shall be made
available to OIG upon request.
F.
Ineligible Persons.
1. Definitions.
For
purposes of this CIA:
a.
an
“Ineligible Person” shall include an individual or entity who:
i. is
currently excluded, debarred, suspended, or otherwise ineligible to participate
in the Federal health care programs or in Federal procurement or nonprocurement
programs; or
ii. has
been convicted of a criminal offense that falls within the ambit of 42 U.S.C.
§
1320a-7(a), but has not yet been excluded, debarred, suspended, or otherwise
declared ineligible.
b.
“Exclusion Lists” include:
i. the
HHS/OIG List of Excluded Individuals/Entities (available through the Internet
at
xxxx://xxx.xxx.xxx.xxx); and
ii. the
General Services Administration’s List of Parties Excluded from Federal Programs
(available through the Internet at
xxxx://xxx.xxxx.xxx).
c.
“Screened Persons” include officers, directors, employees, contractors, and
agents of Maximus.
2.
Screening Requirements. Maximus shall ensure that all Screened Persons are
not Ineligible Persons, by implementing the following screening
requirements.
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a. Maximus
shall screen all Screened Persons against the Exclusion Lists prior to engaging
their services and, as part of the hiring or contracting process, shall require
such Screened Persons to disclose whether they are Ineligible
Persons.
b. Maximus
shall screen all Screened Persons against the Exclusion Lists within 90 days
after the Effective Date and on an annual basis thereafter.
c. Maximus
shall implement a policy requiring all Screened Persons to disclose immediately
any debarment, exclusion, suspension, or other event that makes that person
an
Ineligible Person.
d. Maximus
will include in all future contacts a requirement that Contractors who perform
functions for Maximus that relate to or affect claiming to federal healthcare
programs screen personnel against the Exclusion Lists prior to allowing
personnel to work on Maximus projects that relate to claiming under federal
health care programs.
Nothing
in
this Section affects the responsibility of (or liability for) Maximus to refrain
from billing Federal health care programs for items or services furnished,
ordered, or prescribed by an Ineligible Person. Maximus understands that items
or services furnished by excluded persons are not payable by Federal health
care
programs and that Maximus may be liable for overpayments and/or criminal, civil,
and administrative sanctions for employing or contracting with an excluded
person regardless of whether Maximus meets the requirements of Section
III.F.
3.
Removal
Requirement. If
Maximus has actual notice that a Screened Person has become an Ineligible
Person, Maximus shall remove such Screened Person from responsibility for,
or
involvement with, Maximus’ business operations related to the Federal health
care programs and shall remove such Screened Person from any position for which
the Screened Person’s compensation or the items or services furnished, ordered,
or prescribed by the Screened Person are paid in whole or part, directly or
indirectly, by Federal health care programs or otherwise with Federal funds
at
least until such time as the Screened Person is reinstated into participation
in
the Federal health care programs.
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4. Notification
of Affected Parties of Ineligible Person: If Maximus has actual notice of
that it has employed an Ineligible Person, Maximus will notify in writing within
30 days any person or entity who has submitted or will likely submit claims
to
any Federal health care program for work performed by the Ineligible Person
on
behalf of Maximus.
5. Pending
Charges and Proposed Exclusions. If Maximus has actual notice that a
Screened Person is charged with a criminal offense that falls within the ambit
of 42 U.S.C. §§ 1320a-7(a), 1320a-7(b)(1)-(3), or is proposed for exclusion
during the Screened Person’s employment or contract term, Maximus shall take all
appropriate actions to ensure that the responsibilities of that Screened Person
have not and shall not adversely affect the quality of care rendered to any
beneficiary, patient, or resident, or the accuracy of any claims submitted
to
any Federal health care program.
G. Notification
of Government Investigation or Legal Proceedings.
Within
30
days after discovery, Maximus shall notify OIG, in writing, of any ongoing
investigation or legal proceeding known to Maximus conducted or brought by
a
governmental entity or its agents involving an allegation that Maximus has
committed a crime or has engaged in fraudulent activities. This notification
shall include a description of the allegation, the identity of the investigating
or prosecuting agency, and the status of such investigation or legal proceeding.
Maximus shall also provide written notice to OIG within 30 days after the
resolution of the matter, and shall provide OIG with a description of the
findings and/or results of the investigation or proceedings, if
any.
H. Reporting.
1.
Notification of Affected Parties of Potential Problems with Consulting
Con
tract.
a.
Definition of Potential Problems with Consulting Con tract. For
purposes of this CIA, an “Potential Problems with Consulting Contract” shall
mean information that would lead a reasonable person to believe that entities
for whom Maximus has performed work under a consulting contract have, based
on
recommendations or work done by Maximus representatives, submitted claims that
are not reimbursable under the applicable legal and regulatory provisions of
a
federal healthcare program.
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b.
Reporting of Potential Problems with Consulting Con tract. If, at any
time, Maximus identifies or learns of any Potential Problem with a Consulting
Contract, Maximus shall notify the Client and the appropriate representative
of
the relevant state and/or federal health care program of the potential problem
and take remedial steps where possible within 60 days after identification
(or
such additional time as may be agreed to by the appropriate representative
of
the relevant federal health care program) to correct the problem In addition,
within 60 days after identification, Maximus will undertake a review to
determine any other contracts that are affected by the issue identified and
notify the Client(s) and the appropriate representative of the relevant state
and/or federal health care program of the issue.
2.
Reportable Events.
a. Definition
of Reportable Event. For purposes of this CIA, a “Reportable Event” means
anything that involves:
i. the
Reporting of Potential Problems with Consulting Con tract that
will likely result in a substantial financial impact;
ii. a
matter that a reasonable person would consider a probable violation by Maximus
of criminal, civil, or administrative laws applicable to any Federal health
care
program for which penalties or exclusion may be authorized; or
iii. the
filing of a bankruptcy petition by Maximus; A
Reportable Event may be the result of an isolated event or a series of
occurrences.
b.
Reporting of Reportable Events. If Maximus determines (after a
reasonable opportunity to conduct an appropriate review or investigation of
the
allegations including consultation with the Client) through any means that
there
is a Reportable Event, Maximus shall notify OIG, in writing, within 30 days
after making the determination that the Reportable Event exists. The report
to
OIG shall include the following information:
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i. If
the Reportable Event is Potential Problem with a Consulting Contract , the
report to OIG shall be made at the same time as the notification to the affected
party as required in Section III.H.1, and shall include the affected party’s
name, address, and contact person to whom the Notification was
sent;
ii. a
complete description of the Reportable Event, including the relevant facts,
persons involved, and legal and Federal health care program authorities
implicated;
iii. a
description of Maximus’ actions taken to correct the Reportable Event;
and
iv. any
further steps Maximus plans to take to address the Reportable Event and prevent
it from recurring.
v. If
the Reportable Event involves the filing of a bankruptcy petition, the report
to
the OIG shall include documentation of the filing.
IV. NEW
BUSINESS
UNITS
OR LOCATIONS
In
the
event that, after the Effective Date, Maximus changes locations or sells,
closes, purchases, or establishes a new business unit or location related to
the
furnishing of items or services that may be reimbursed by Federal health care
programs, Maximus shall notify OIG of this fact as soon as possible, but no
later than within 30 days after the date of change of location, sale, closure,
purchase, or establishment. This notification shall include the address of
the
new business unit or location, phone number, fax number, each new business
unit
or location shall be subject to all the requirements of this CIA.
V. IMPLEMENTATION
AND
ANNUAL
REPORTS
A.
Implementation Report. Within 120 days after the Effective Date, Maximus
shall submit a written report to OIG summarizing the status of its
implementation of the requirements of this CIA (Implementation Report). The
Implementation Report shall, at a minimum, include:
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1. the
name, address, phone number, and position description of the Compliance Officer
required by Section III.A, and a summary of other noncompliance job
responsibilities the Compliance Officer may have;
2. the
names and positions of the members of the Compliance Committee required by
Section III.A;
3. a
copy of Maximus’ Code of Conduct required by Section III.B.1;
4. a
copy of all Policies and Procedures required by Section III.B.2;
5. the
number of individuals required to complete the Code of Conduct certification
required by Section III.B. 1, the percentage of individuals who have completed
such certification, and an explanation of any exceptions (the documentation
supporting this information shall be available to OIG, upon
request);
6. the
following information regarding each type of training required by Section
III.C:
a.
a
description of such training, including a summary of the topics covered, the
length of sessions and a schedule of training sessions;
b.
the number of individuals required to be trained, percentage of individuals
actually trained, and an explanation of any exceptions.
A
copy of
all training materials and the documentation supporting this information shall
be available to OIG, upon request.
7. a
description of the Disclosure Program required by Section III.E;
8. a
description of the process by which Maximus fulfills the requirements of Section
III.F regarding Ineligible Persons;
9. the
name, title, and responsibilities of any person who is determined to be an
Ineligible Person under Section III.F; the actions taken in response to the
screening and removal obligations set forth in Section III.F; and the actions
taken to notify the State or governmental entity for which the ineligible person
performed work on behalf of Maximus;
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10.
a list
of all of Maximus’ locations (including locations and mailing addresses); the
corresponding name under which each location is doing business; the
corresponding phone numbers and fax numbers;
11. a
description of Maximus’ corporate structure, including
identification of any parent and sister companies, subsidiaries, and their
respective lines of business; and
12. the
certifications required by Section V.C.
B.
Annual Reports. Maximus shall submit to OIG annually a report with
respect to the status of, and findings regarding, Maximus’ compliance activities
for each of the five Reporting Periods (Annual Report).
Each
Annual Report shall include, at a minimum:
1. any
change in the identity, position description, or other noncompliance job
responsibilities of the Compliance Officer and any change in the membership
of
the Compliance Committee described in Section III.A;
2. a
summary of any significant changes or amendments to the Policies and Procedures
required by Section III.B and the reasons for such changes (e.g., change
in contractor policy);
3. the
number of individuals required to complete the Code of Conduct certification
required by Section III.B. 1, the percentage of individuals who have completed
such certification, and an explanation of any exceptions (the documentation
supporting this information shall be available to OIG, upon
request);
4. the
following information regarding each type of training required by Section
III.C:
a. a
description of such training, including a summary of the topics covered, the
length of sessions and a schedule of training sessions;
b. the
number of individuals required to be trained, percentage of individuals actually
trained, and an explanation of any exceptions.
17
A
copy of
all training materials and the documentation supporting this information shall
be available to OIG, upon request.
5. a
complete copy of all reports prepared pursuant to Section III.D, along with
a
copy of the OAS’s engagement letter (if applicable);
6. Maximus’
response and corrective action plan(s) related to any issues raised by the
reports prepared pursuant to Section III.D;
7. a
summary of Reportable Events (as defined in Section III.H) identified during
the
Reporting Period and the status of any corrective and preventative action
relating to all such Reportable Events;
8. a
report of the aggregate Notifications of Potential Problems with Consulting
Contracts broken down into the following categories: State or governmental
entity(s); description of cause for problem; and other states or governmental
entity(s) with same or similar methodology.
9. a
summary of the disclosures in the disclosure log required by Section III.E
that
relate to Federal health care programs.
10.
any
changes to the process by which Maximus fulfills the requirements of Section
III.F regarding Ineligible Persons;
11. the
name, title, and responsibilities of any person who is determined to be an
Ineligible Person under Section III.F; the actions taken by Maximus in response
to the screening and removal obligations set forth in Section III.F; and the
actions taken to notify all states or governmental entity(s) under whose
contract the Ineligible Person performed work on behalf of Maximus;
12. a
summary describing any ongoing investigation or legal proceeding required to
have been reported pursuant to Section III.G. The summary shall include a
description of the allegation, the identity of the investigating or prosecuting
agency, and the status of such investigation or legal proceeding;
13. a
description of all changes to the most recently provided list of Maximus’
locations (including addresses) as required by Section V.A.12; the corresponding
name under which each location is doing business; the corresponding phone
numbers and fax numbers;
18
14.
the
certifications required by Section V.C.
The
first
Annual Report shall be received by OIG no later than 60 days after the end
of
the first Reporting Period. Subsequent Annual Reports shall be received by
OIG
no later than the anniversary date of the due date of the first Annual
Report.
C. Certifications.
The Implementation Report and Annual Reports shall include a certification
by
the Compliance Officer that:
1. to
the best of his or her knowledge, except as otherwise described in the
applicable report, Maximus is in compliance with all of the requirements of
this
CIA;
2. he
or she has reviewed the Report and has made reasonable inquiry regarding its
content and believes that the information in the Report is accurate and
truthful; and
D. Designation
of Information. Maximus shall clearly identify any portions of its
submissions that it believes are trade secrets, or information that is
commercial or financial and privileged or confidential, and therefore
potentially exempt from disclosure under the Freedom of Information Act (FOIA),
5 U.S.C. § 552. Maximus shall refrain from identifying any information as exempt
from disclosure if that information does not meet the criteria for exemption
from disclosure under FOIA.
VI.
NOTIFICATIONS
AND
SUBMISSION
OF
REPORTS
Unless
otherwise stated in writing after the Effective Date, all notifications and
reports required under this CIA shall be submitted to the following
entities:
OIG:
Administrative
and Civil Remedies Branch
Office
of
Counsel to the Inspector General
Office
of
Inspector General
U.S.
Department of Health and Human Services
Xxxxx
Building, Room 5527
000
Xxxxxxxxxxxx Xxxxxx, X.X.
Xxxxxxxxxx,
XX 00000
Telephone:
000.000.0000
Facsimile:
202.205.0604
19
Maximus:
Xxxxxxxx
Xxxxxx
MAXIMUS,
Inc.
0000
Xxxxxxx Xxxx
XxXxxx,
Xxxxxxxx 00000
Fax
(000)
000-0000
Unless
otherwise specified, all notifications and reports required by this CIA may
be
made by certified mail, overnight mail, hand delivery, or other means, provided
that there is proof that such notification was received. For purposes of this
requirement, internal facsimile confirmation sheets do not constitute proof
of
receipt.
VII. OIG
INSPECTION,
AUDIT,
AND
REVIEW
RIGHTS
In
addition to any other rights OIG may have by statute, regulation, or contract,
OIG or its duly authorized representative(s) may examine or request copies
of
Maximus’ books, records, and other documents and supporting materials and/or
conduct on-site reviews of any of Maximus’ locations for the purpose of
verifying and evaluating: (a) Maximus’ compliance with the terms of this CIA;
and (b) Maximus’ compliance with the requirements of the Federal health care
programs in which it participates. The documentation described above shall
be
made available by Maximus to OIG or its duly authorized representative(s) at
all
reasonable times for inspection, audit, or reproduction. Furthermore, for
purposes of this provision, OIG or its duly authorized representative(s) may
interview any of Maximus’ employees, contractors, or agents who consent to be
interviewed at the individual’s place of business during normal business hours
or at such other place and time as may be mutually agreed upon between the
individual and OIG. Maximus shall assist OIG or its duly authorized
representative(s) in contacting and arranging interviews with such individuals
upon OIG’s request. Maximus’ employees may elect to be interviewed with or
without a representative of Maximus present.
VIII. DOCUMENT
AND RECORD
RETENTION
Maximus
shall maintain for inspection all documents and records relating to work
performed under a contract that relates to reimbursement from the Federal health
care programs, or to compliance with this CIA, for 6 years (or longer if
otherwise required by law) from the Effective Date.
20
IX. DISCLOSURES
Consistent
with HHS’s FOIA procedures, set forth in 45 C.F.R. Part 5, OIG shall make a
reasonable effort to notify Maximus prior to any release by OIG of information
submitted by Maximus pursuant to its obligations under this CIA and identified
upon submission by Maximus as trade secrets, or information that is commercial
or financial and privileged or confidential, under the FOIA rules. With respect
to such releases, Maximus shall have the rights set forth at 45 C.F.R. §
5.65(d).
X. BREACH
AND DEFAULT
PROVISIONS
Maximus
is
expected to fully and timely comply with all of its CIA
obligations.
A.
Stipulated Penalties for Failure to Comply with Certain Obligations. As a
contractual remedy, Maximus and OIG hereby agree that failure to comply with
certain obligations as set forth in this CIA may lead to the imposition of
the
following monetary penalties (hereinafter referred to as “Stipulated Penalties”)
in accordance with the following provisions.
1.
A
Stipulated Penalty of $2,500 (which shall begin to accrue on the day after
the
date the obligation became due) for each day Maximus fails to establish and
implement any of the following obligations as described in Section
III:
a. a
Compliance Officer;
b. a
Compliance Committee;
c. a
written Code of Conduct;
d. written
Policies and Procedures;
e. the
training of Covered Persons;
f. a
Disclosure Program;
g. Ineligible
Persons screening and removal requirements; and
h. notification
of Government investigations or legal proceedings.
21
2. A
Stipulated Penalty of $2,500 (which shall begin to accrue on the day after
the
date the obligation became due) for each day Maximus fails to pay an invoice
of
OAS within 30 days of the receipt from OAS as required in Section
III.D.
3. A
Stipulated Penalty of $2,500 (which shall begin to accrue on the day after
the
date the obligation became due) for each day Maximus fails to submit the
Implementation Report or any Annual Reports to OIG in accordance with the
requirements of Section V by the deadlines for submission.
4. A
Stipulated Penalty of $2,500 (which shall begin to accrue on the day after
the
date the obligation became due) for each day Maximus fails to notify affected
parties of a Potential Problem with Consulting Contract in accordance with
requirements of Section III.H
5. A
Stipulated Penalty of $2,500 (which shall begin to accrue on the day after
the
date the obligation became due) for each day Maximus fails to submit the annual
Consulting Contract Review in accordance with the requirements of Section
III.D.
6. A
Stipulated Penalty of $1,500 for each day Maximus fails to grant access as
required in Section VII. (This Stipulated Penalty shall begin to accrue on
the
date Maximus fails to grant access.)
7. A
Stipulated Penalty of $5,000 for each false certification submitted by or on
behalf of Maximus as part of its Implementation Report, Annual Report,
additional documentation to a report (as requested by the OIG), or otherwise
required by this CIA.
8. A
Stipulated Penalty of $1,000 for each day Maximus fails to comply fully and
adequately with any obligation of this CIA. OIG shall provide notice to Maximus
stating the specific grounds for its determination that Maximus has failed
to
comply fully and adequately with the CIA obligation(s) at issue and steps
Maximus shall take to comply with the CIA. (This Stipulated Penalty shall begin
to accrue 10 days after Maximus receives this notice from OIG of the failure
to
comply.) A Stipulated Penalty as described in this Subsection shall not be
demanded for any violation for which OIG has sought a Stipulated Penalty under
Subsections 1-6 of this Section.
B.
Timely Written Requests for Extensions. Maximus may, in advance of the
due date, submit a timely written request for an extension of time to perform
any act or file any notification or report required by this CIA. Notwithstanding
any other provision in this Section, if OIG grants the timely written request
with respect to an act, notification, or
report,
Stipulated Penalties for failure to perform the act or file the notification
or
report shall not begin to accrue until one day after Maximus fails to meet
the
revised deadline set by OIG. Notwithstanding any other provision in this
Section, if OIG denies such a timely written request, Stipulated Penalties
for
failure to perform the act or file the notification or report shall not begin
to
accrue until three business days after Maximus receives OIG’s written denial of
such request or the original due date, whichever is later. A “timely written
request” is defined as a request in writing received by OIG at least five
business days prior to the date by which any act is due to be performed or
any
notification or report is due to be filed.
22
C.
Payment of Stipulated Penalties.
1. Demand
Letter. Upon a finding that Maximus has failed to comply with any of the
obligations described in Section X.A and after determining that Stipulated
Penalties are appropriate, OIG shall notify Maximus of: (a) Maximus’ failure to
comply; and (b) OIG’s exercise of its contractual right to demand payment of the
Stipulated Penalties (this notification is referred to as the “Demand
Letter”).
2. Response
to Demand Letter. Within 10 days after the receipt of the Demand Letter,
Maximus shall either: (a) cure the breach to OIG’s satisfaction and pay the
applicable Stipulated Penalties or (b) request a hearing before an HHS
administrative law judge (ALJ) to dispute OIG’s determination of noncompliance,
pursuant to the agreed upon provisions set forth below in Section X.E. In the
event Maximus elects to request an ALJ hearing, the Stipulated Penalties shall
continue to accrue until Maximus cures, to OIG’s satisfaction, the alleged
breach in dispute. Failure to respond to the Demand Letter in one of these
two
manners within the allowed time period shall be considered a material breach
of
this CIA and shall be grounds for exclusion under Section X.D.
3. Form
of Payment. Payment of the Stipulated Penalties shall be made by certified
or cashier’s check, payable to: “Secretary of the Department of Health and Human
Services,” and submitted to OIG at the address set forth in Section
VI.
4. Independence
from Material Breach Determination. Except as set forth in Section X.D. 1
.c, these provisions for payment of Stipulated Penalties shall not affect or
otherwise set a standard for OIG’s decision that Maximus has materially breached
this CIA, which decision shall be made at OIG’s discretion and shall be governed
by the provisions in Section X.D, below.
23
D.
Exclusion for Material Breach of this CIA.
1.
Definition of Material Breach. A material breach of this CIA
means:
a. a
failure by Maximus to report a Reportable Event, take corrective action, and
make the appropriate refunds, as required in Section III.H;
b. a
repeated or flagrant violation of the obligations under this CIA, including,
but
not limited to, the obligations addressed in Section X.A;
c. a
failure to respond to a Demand Letter concerning the payment of Stipulated
Penalties in accordance with Section X.C; or
d. a
failure to engage OAS in accordance with Section III.D.
2.
Notice of Material Breach and Intent to Exclude. The parties agree that
a material breach of this CIA by Maximus constitutes an independent basis for
Maximus’ exclusion from participation in the Federal health care programs. Upon
a determination by OIG that Maximus has materially breached this CIA and that
exclusion is the appropriate remedy, OIG shall notify Maximus of: (a) Maximus’
material breach; and (b) OIG’s intent to exercise its contractual right to
impose exclusion (this notification is hereinafter referred to as the “Notice of
Material Breach and Intent to Exclude”).
3.
Opportunity to Cure. Maximus shall have 30 days from the date of
receipt of the Notice of Material Breach and Intent to Exclude to demonstrate
to
OIG’s satisfaction that:
a. Maximus
is in compliance with the obligations of the CIA cited by OIG as being the
basis
for the material breach;
b. the
alleged material breach has been cured; or
c. the
alleged material breach cannot be cured within the 30-day period, but that:
(i)
Maximus has begun to take action to cure the material breach; (ii) Maximus
is
pursuing such action with due diligence; and (iii) Maximus has provided to
OIG a
reasonable timetable
for curing the material breach.
24
4.
Exclusion Letter. If, at the conclusion of the 30-day period, Maximus
fails to satisfy the requirements of Section X.D.3, OIG may exclude Maximus
from
participation in the Federal health care programs. OIG shall notify Maximus
in
writing of its determination to exclude Maximus (this letter shall be referred
to hereinafter as the “Exclusion Letter”). Subject to the Dispute Resolution
provisions in Section X.E, below, the exclusion shall go into effect 30 days
after the date of Maximus’ receipt of the Exclusion Letter. The exclusion shall
have national effect and shall also apply to all other Federal procurement
and
nonprocurement programs. Reinstatement to program participation is not
automatic. After the end of the period of exclusion, Maximus may apply for
reinstatement by submitting a written request for reinstatement in accordance
with the provisions at 42 C.F.R. §§ 1001.3001-.3004.
E.
Dispute Resolution
1. Review
Rights. Upon OIG’s delivery to Maximus of its Demand Letter or of its
Exclusion Letter, and as an agreed-upon contractual remedy for the resolution
of
disputes arising under this CIA, Maximus shall be afforded certain review rights
comparable to the ones that are provided in 42 U.S.C. § 1320a-7(f) and 42 C.F.R.
Part 1005 as if they applied to the Stipulated Penalties or exclusion sought
pursuant to this CIA. Specifically, OIG’s determination to demand payment of
Stipulated Penalties or to seek exclusion shall be subject to review by an
HHS
ALJ and, in the event of an appeal, the HHS Departmental Appeals Board (DAB),
in
a manner consistent with the provisions in 42 C.F.R. § 1005.2-1005.2 1.
Notwithstanding the language in 42 C.F.R. § 1005.2(c), the request for a hearing
involving Stipulated Penalties shall be made within 10 days after receipt of
the
Demand Letter and the request for a hearing involving exclusion shall be made
within 25 days after receipt of the Exclusion Letter.
2. Stipulated
Penalties Review. Notwithstanding any provision of Title 42 of the United
States Code or Title 42 of the Code of Federal Regulations, the only issues
in a
proceeding for Stipulated Penalties under this CIA shall be: (a) whether Maximus
was in full and timely compliance with the obligations of this CIA for which
OIG
demands payment; and (b) the period of noncompliance. Maximus shall have the
burden of proving its full and timely compliance and the steps taken to cure
the
noncompliance, if any. OIG shall not have the right to appeal to the DAB an
adverse ALJ decision related to Stipulated Penalties. If the ALJ agrees with OIG
with regard to a finding of a breach of this CIA and orders Maximus to pay
Stipulated Penalties, such Stipulated Penalties shall become due and payable
20
days after the ALJ issues such a decision unless
Maximus requests review of the ALJ decision by the DAB. If the ALJ decision
is
properly appealed to the DAB and the DAB upholds the determination of OIG,
the
Stipulated Penalties shall become due and payable 20 days after the DAB issues
its decision.
25
3. Exclusion
Review.
Notwithstanding any provision of Title 42 of the United States
Code
or Title 42 of the Code of Federal Regulations, the only issues in a proceeding
for exclusion based on a material breach of this CIA shall be:
a. whether
Maximus was in material breach of this CIA;
b. whether
such breach was continuing on the date of the Exclusion Letter; and
c. whether
the alleged material breach could not have been cured within the 30-day period,
but that: (i) Maximus had begun to take action to cure the material breach
within that period; (ii) Maximus has pursued and is pursuing such action with
due diligence; and (iii) Maximus provided to OIG within that period a reasonable
timetable for curing the material breach and Maximus has followed the
timetable.
For
purposes of the exclusion herein, exclusion shall take effect only after an
ALJ
decision favorable to OIG, or, if the ALJ rules for Maximus, only after a DAB
decision in favor of OIG. Maximus’ election of its contractual right to appeal
to the DAB shall not abrogate OIG’s authority to exclude Maximus upon the
issuance of an ALJ’s decision in favor of OIG. If the ALJ sustains the
determination of OIG and determines that exclusion is authorized, such exclusion
shall take effect 20 days after the ALJ issues such a decision, notwithstanding
that Maximus may request review of the ALJ decision by the DAB. If the DAB
finds
in favor of OIG after an ALJ decision adverse to OIG, the exclusion shall take
effect 20 days after the DAB decision. Maximus shall waive its right to any
notice of such an exclusion if a decision upholding the exclusion is rendered
by
the ALJ or DAB. If the DAB finds in favor of Maximus, Maximus shall be
reinstated effective on the date of the original exclusion.
4. Finality
of Decision.
The review by an ALJ or DAB provided for above shall not be
considered to be an appeal right arising under any statutes or regulations.
Consequently, the parties to this CIA agree that the DAB’s decision (or the
ALJ’s decision if not appealed) shall be considered final for all purposes under
this CIA.
26
XI.
EFFECTIVE
AND BINDING
AGREEMENT
Maximus
and OIG agree as follows:
A. This
CIA shall be binding on the successors, assigns, and transferees of
Maximus;
B. This
CIA shall become final and binding on the date the final signature is obtained
on the CIA;
C. This
CIA constitutes the complete agreement between the parties and may not be
amended except by written consent of the parties to this CIA;
D. OIG
may agree to a suspension of Maximus’ obligations under the CIA in the event of
Maximus’ cessation of participation in Federal health care programs. If Maximus
withdraws from participation in Federal health care programs and is relieved
of
its CIA obligations by OIG, Maximus shall notify OIG at least 30 days in advance
of Maximus’ intent to reapply as a participating provider or supplier with any
Federal health care program. Upon receipt of such notification, OIG shall
evaluate whether the CIA should be reactivated or modified.
E. The
undersigned Maximus signatories represent and warrant that they are authorized
to execute this CIA. The undersigned OIG signatory represents that he is signing
this CIA in his official capacity and that he is authorized to execute this
CIA.
F. This
CIA may be executed in counterparts, each of which constitutes an original
and
all of which constitute one and the same CIA. Facsimiles of signatures shall
constitute acceptable, binding signatures for purposes of this CIA.
27
ON
BEHALF
OF MAXIMUS
/s/
XXXXX X. XXXXXXX
|
July 20, 2007 | |||
XXXXX
X. XXXXXXX
General
Counsel and Secretary
MAXIMUS,
Inc.
|
DATE |
28
ON
BEHALF OF THE OFFICE OF INSPECTOR GENERAL
OF
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
/s/
XXXXXXX X. XXXXXX
|
7/20/07 | |||
XXXXXXX
X. XXXXXX
Assistant
Inspector General for Legal Affairs
Office
of Inspector General
U.S.
Department of Health and Human Services
|
DATE |
29