{"component": "clause", "props": {"groups": [{"samples": [{"hash": "d4Dr1eY5un9", "uri": "/contracts/d4Dr1eY5un9#iro-independence-and-objectivity", "label": "Integrity Agreement", "score": 23.9062286105, "published": true}], "size": 3, "snippet": "\u200c The IRO must perform each component of the IRO Reviews in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the U.S. Government Accountability Office. The Legal Reviewer retained by the IRO shall not: (1) currently be employed or engaged by Good Days; (2) currently represent Good Days or a current, past, or potential Donor to Good Days; or (3) have a current or prior relationship with Good Days, or a current, past, or potential Donor to Good Days that would cause a reasonable person to question such individual\u2019s objectivity in performing such reviews.", "snippet_links": [{"key": "most-recent", "type": "definition", "offset": [130, 141]}, {"key": "government-auditing-standards", "type": "definition", "offset": [142, 171]}, {"key": "issued-by", "type": "definition", "offset": [172, 181]}, {"key": "the-us", "type": "clause", "offset": [182, 189]}, {"key": "government-accountability-office", "type": "definition", "offset": [191, 223]}, {"key": "potential-donor", "type": "definition", "offset": [383, 398]}, {"key": "prior-relationship", "type": "definition", "offset": [438, 456]}, {"key": "a-reasonable-person", "type": "definition", "offset": [542, 561]}], "hash": "3eb164a509c0cfb32c56ad4446c81e0e", "id": 6}, {"samples": [{"hash": "lJvGmWiS69o", "uri": "/contracts/lJvGmWiS69o#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 30.340862423, "published": true}, {"hash": "j0XffXvLZKw", "uri": "/contracts/j0XffXvLZKw#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement (Lilly Eli & Co)", "score": 19.0, "published": true}], "size": 10, "snippet": "The IRO must perform the Promotional and Product Services Review in a professionally independent and objective fashion, as appropriate to the nature of the engagement, taking into account any other business relationships or engagements that may exist between the IRO and Lilly.", "snippet_links": [{"key": "product-services", "type": "definition", "offset": [41, 57]}, {"key": "nature-of-the-engagement", "type": "clause", "offset": [142, 166]}, {"key": "other-business-relationships", "type": "clause", "offset": [192, 220]}], "hash": "4fccc75139dbc645b9ecce9db6529007", "id": 3}, {"samples": [{"hash": "jxQ8TJ2TKiy", "uri": "/contracts/jxQ8TJ2TKiy#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 33.3711797958, "published": true}, {"hash": "ii5NuvlBbvJ", "uri": "/contracts/ii5NuvlBbvJ#iro-independence-and-objectivity", "label": "Integrity Agreement", "score": 33.3657050606, "published": true}, {"hash": "2eFbfPPeG2u", "uri": "/contracts/2eFbfPPeG2u#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 33.257703467, "published": true}], "size": 297, "snippet": "The IRO must perform the Claims Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the U.S. Government Accountability Office.", "snippet_links": [{"key": "claims-review", "type": "definition", "offset": [25, 38]}, {"key": "most-recent", "type": "definition", "offset": [112, 123]}, {"key": "government-auditing-standards", "type": "definition", "offset": [124, 153]}, {"key": "issued-by", "type": "definition", "offset": [154, 163]}, {"key": "the-us", "type": "clause", "offset": [164, 171]}, {"key": "government-accountability-office", "type": "definition", "offset": [173, 205]}], "hash": "1b9e65beee2fb76a4480890532ac9b96", "id": 1}, {"samples": [{"hash": "9LaC5q96SwC", "uri": "/contracts/9LaC5q96SwC#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 19.3696098563, "published": true}], "size": 19, "snippet": "The IRO must perform the IRO Review in a professionally independent and objective fashion, as appropriate to the nature of the engagement, taking into account any other business relationships or engagements that may exist between the IRO and Novartis.", "snippet_links": [{"key": "iro-review", "type": "clause", "offset": [25, 35]}, {"key": "nature-of-the-engagement", "type": "clause", "offset": [113, 137]}, {"key": "other-business-relationships", "type": "clause", "offset": [163, 191]}], "hash": "aa0deebc5446821c9cd4ce2b0e354742", "id": 2}, {"samples": [{"hash": "alkMwjnezcU", "uri": "/contracts/alkMwjnezcU#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement (Quorum Health Corp)", "score": 24.8836413415, "published": true}, {"hash": "8d3voJpTMR4", "uri": "/contracts/8d3voJpTMR4#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement (Community Health Systems Inc)", "score": 23.8405201916, "published": true}], "size": 5, "snippet": "The IRO must perform the Inpatient Medical Necessity and Appropriateness Review and Arrangements Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the United States Government Accountability Office. Community Health Systems, Inc. 2 Corporate Integrity Agreement - Appendix A", "snippet_links": [{"key": "inpatient-medical-necessity-and-appropriateness-review", "type": "clause", "offset": [25, 79]}, {"key": "arrangements-review", "type": "clause", "offset": [84, 103]}, {"key": "most-recent", "type": "definition", "offset": [177, 188]}, {"key": "government-auditing-standards", "type": "definition", "offset": [189, 218]}, {"key": "issued-by", "type": "definition", "offset": [219, 228]}, {"key": "government-accountability-office", "type": "definition", "offset": [247, 279]}, {"key": "community-health-systems", "type": "definition", "offset": [281, 305]}, {"key": "corporate-integrity-agreement", "type": "definition", "offset": [314, 343]}, {"key": "appendix-a", "type": "clause", "offset": [346, 356]}], "hash": "51867e93e252b530bc3aeaf5636da3bc", "id": 4}, {"samples": [{"hash": "3431aXvoLJE", "uri": "/contracts/3431aXvoLJE#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement (Kindred Healthcare, Inc)", "score": 25.0287474333, "published": true}, {"hash": "6CHdoOTRsdj", "uri": "/contracts/6CHdoOTRsdj#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 24.9867185728, "published": true}], "size": 4, "snippet": "The IRO must perform the Rehab Medical Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the U.S. Government Accountability Office.", "snippet_links": [{"key": "medical-review", "type": "clause", "offset": [31, 45]}, {"key": "most-recent", "type": "definition", "offset": [119, 130]}, {"key": "government-auditing-standards", "type": "definition", "offset": [131, 160]}, {"key": "issued-by", "type": "definition", "offset": [161, 170]}, {"key": "the-us", "type": "clause", "offset": [171, 178]}, {"key": "government-accountability-office", "type": "definition", "offset": [180, 212]}], "hash": "eff7fcd455b7afe4466f9e6dd6b67202", "id": 5}, {"samples": [{"hash": "ccmLgGmAZiU", "uri": "/contracts/ccmLgGmAZiU#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 22.0896646133, "published": true}, {"hash": "a0EOOaAk4UJ", "uri": "/contracts/a0EOOaAk4UJ#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 22.0814510609, "published": true}], "size": 2, "snippet": "1. In order to maintain independence in fact and appearance, the IRO shall not have any additional business relationships or engagements, beyond the IRO engagement, with the Provider during the term of the CIA. Upon engagement and included as part of every submission to OMIG, the IRO shall certify to this independence and objectivity taking into consideration the Role of the IRO (Section II.A) under this Appendix. In making the certification of its independence and objectivity required under a CIA, the IRO should consider whether there are personal, external, or organizational impairments1 to independence.\n2. The IRO shall report to OMIG within 10 days, any offer of employment or engagement made to the IRO by the Provider beyond the IRO\u2019s responsibilities specified in this Appendix.", "snippet_links": [{"key": "to-maintain", "type": "clause", "offset": [12, 23]}, {"key": "business-relationships", "type": "clause", "offset": [99, 121]}, {"key": "iro-engagement", "type": "clause", "offset": [149, 163]}, {"key": "term-of-the-cia", "type": "clause", "offset": [194, 209]}, {"key": "independence-and-objectivity", "type": "clause", "offset": [307, 335]}, {"key": "taking-into-consideration", "type": "clause", "offset": [336, 361]}, {"key": "role-of-the", "type": "clause", "offset": [366, 377]}, {"key": "certification-of", "type": "clause", "offset": [432, 448]}, {"key": "report-to", "type": "definition", "offset": [631, 640]}, {"key": "offer-of-employment", "type": "definition", "offset": [666, 685]}, {"key": "by-the-provider", "type": "clause", "offset": [716, 731]}], "hash": "8e87fb47f41b7056a6d7ebd01577992c", "id": 7}, {"samples": [{"hash": "iqGJ5TGgIBx", "uri": "/contracts/iqGJ5TGgIBx#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 23.3825254958, "published": true}, {"hash": "eMzxdxugDie", "uri": "/contracts/eMzxdxugDie#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 21.1916495551, "published": true}], "size": 2, "snippet": "A. Interventional Cardiac Procedures IRO The Interventional Cardiac Procedures IRO must perform the Interventional Cardiac Procedures Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the United States Government Accountability Office.\nB. Legal IRO\u2019s Independence and Objectivity and Relationship to KDMC The entity that KDMC selects to serve as the Legal IRO must perform the Arrangements Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the United States Government Accountability Office. Additionally, the Legal IRO shall not have a relationship to KDMC or its employees, officers, or directors that would cause a reasonable person to question the Legal IRO\u2019s impartiality.", "snippet_links": [{"key": "procedures-review", "type": "clause", "offset": [123, 140]}, {"key": "most-recent", "type": "definition", "offset": [214, 225]}, {"key": "government-auditing-standards", "type": "definition", "offset": [226, 255]}, {"key": "issued-by", "type": "definition", "offset": [256, 265]}, {"key": "government-accountability-office", "type": "definition", "offset": [284, 316]}, {"key": "independence-and-objectivity", "type": "clause", "offset": [333, 361]}, {"key": "the-entity", "type": "clause", "offset": [387, 397]}, {"key": "to-serve", "type": "definition", "offset": [416, 424]}, {"key": "arrangements-review", "type": "clause", "offset": [459, 478]}, {"key": "a-reasonable-person", "type": "definition", "offset": [780, 799]}], "hash": "db0aafe54bb4a4eb3920c78610c00d28", "id": 8}, {"samples": [{"hash": "gVJefYX9j6Z", "uri": "/contracts/gVJefYX9j6Z#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 28.8225941789, "published": true}], "size": 2, "snippet": "\u200c The IRO must perform the Chart Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the U.S. Government Accountability Office.", "snippet_links": [{"key": "chart-review", "type": "clause", "offset": [27, 39]}, {"key": "most-recent", "type": "definition", "offset": [113, 124]}, {"key": "government-auditing-standards", "type": "definition", "offset": [125, 154]}, {"key": "issued-by", "type": "definition", "offset": [155, 164]}, {"key": "the-us", "type": "clause", "offset": [165, 172]}, {"key": "government-accountability-office", "type": "definition", "offset": [174, 206]}], "hash": "53f791789c3d76456d41a9eb985c087d", "id": 9}, {"samples": [{"hash": "dbxhs3yo8z3", "uri": "/contracts/dbxhs3yo8z3#iro-independence-and-objectivity", "label": "Corporate Integrity Agreement", "score": 31.6603250582, "published": true}], "size": 1, "snippet": "\u200c The IRO must perform the MLR Element Review in a professionally independent and objective fashion, as defined in the most recent Government Auditing Standards issued by the U.S. Government Accountability Office.\u200c", "snippet_links": [{"key": "most-recent", "type": "definition", "offset": [119, 130]}, {"key": "government-auditing-standards", "type": "definition", "offset": [131, 160]}, {"key": "issued-by", "type": "definition", "offset": [161, 170]}, {"key": "the-us", "type": "clause", "offset": [171, 178]}], "hash": "ac92e3227a425785fdf995eaa903844c", "id": 10}], "next_curs": "CmkSY2oVc35sYXdpbnNpZGVyY29udHJhY3RzckULEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2Iilpcm8taW5kZXBlbmRlbmNlLWFuZC1vYmplY3Rpdml0eSMwMDAwMDAwYQyiAQJlbhgAIAA=", "clause": {"title": "IRO Independence and Objectivity", "size": 353, "children": [["recommendations", "Recommendations"], ["oig-removal-of-iro", "OIG Removal of IRO"], ["reporting-of-findings", "Reporting of Findings"], ["chart-review-report", "Chart Review Report"], ["risk-adjusted-members-without-supporting-documentation", "Risk Adjusted Members without Supporting Documentation"]], "parents": [["effective-and-binding-agreement", "EFFECTIVE AND BINDING AGREEMENT"], ["finality-of-decision", "Finality of Decision"], ["third-party-billing", "Third Party Billing"], ["dispute-resolution", "Dispute Resolution"], ["reportable-events", "Reportable Events"]], "id": "iro-independence-and-objectivity", "related": [["independence-and-objectivity-certification", "Independence and Objectivity Certification", "Independence and Objectivity Certification"], ["scope-and-objectives", "Scope and Objectives", "Scope and Objectives"], ["aims-and-objectives", "Aims and Objectives", "Aims and Objectives"], ["goals-and-objectives", "Goals and Objectives", "Goals and Objectives"], ["background-and-objectives", "BACKGROUND AND OBJECTIVES", "BACKGROUND AND OBJECTIVES"]], "related_snippets": [], "updated": "2025-07-07T12:37:53+00:00", "also_ask": ["What safeguards ensure true independence and objectivity of the IRO under this clause?", "Which drafting elements are essential to prevent conflicts of interest for the IRO?", "How can parties negotiate the IRO selection process to maximize impartiality?", "What are the main legal risks if the IRO\u2019s independence is challenged in court?", "How does this clause compare to industry standards or regulatory requirements for IRO independence?"], "drafting_tip": "Specify the IRO's reporting lines and decision-making autonomy to prevent conflicts of interest; require disclosure of potential biases to maintain trust and transparency.", "explanation": "The IRO Independence and Objectivity clause establishes that the Independent Review Organization (IRO) must remain impartial and free from conflicts of interest when conducting its duties. In practice, this means the IRO cannot have financial or personal ties to the parties involved in the review, and must disclose any potential conflicts before accepting an assignment. This clause ensures that the IRO\u2019s findings and recommendations are unbiased, thereby maintaining the integrity and credibility of the review process."}, "json": true, "cursor": ""}}