Office of Inspector General, U.S. Department of Health and Human Services

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The Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS) is charged with identifying and combating waste, fraud, and abuse in the HHS’s more than 300 programs, including Medicare and programs conducted by agencies within HHS, such as the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. Since 2004, Daniel R. Levinson has served as HHS’s Inspector General, a presidentially appointed, nonpartisan position.

United States Department of Health and Human Services department of the US federal government

The United States Department of Health & Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law, a criminal law, or it may cause no loss of money, property or legal right but still be an element of another civil or criminal wrong. The purpose of fraud may be monetary gain or other benefits, for example by obtaining a passport, travel document, or driver's license, or mortgage fraud, where the perpetrator may attempt to qualify for a mortgage by way of false statements.

Medicare (United States) United States single-payer national social insurance program

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older, younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, and general U.S. Treasury revenue.

Contents

Mission

The mission of the OIG as mandated by the Inspector General Act (Public Law 95-452, as amended), is to protect the integrity of HHS’s programs as well as the well-being of the beneficiaries of those programs.

Inspector General Act of 1978 United States oversight law

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OIG holds accountable those who bill HHS programs but do not meet Federal health program requirements or who violate Federal laws regarding the use of Federal health care funds. OIG also identifies opportunities to improve the economy, efficiency, and effectiveness of HHS programs.

OIG reports both to the Secretary of HHS and to the United States Congress about program and management problems and recommendations to correct them. OIG's work is carried out by regional offices nationwide that perform audits, investigations, inspections and other mission-related functions.

United States Congress Legislature of the United States

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HHS OIG is the largest inspector general's office in the Federal Government, with more than 1,700 employees dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs. Most of OIG's resources go to overseeing Medicare and Medicaid — programs that represent much of the Federal budget and affect the most vulnerable U.S. citizens. OIG's oversight extends to programs under other HHS institutions, including the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration.

Components

The OIG consists of the following six components:

The Office of Investigations (OI) conducts criminal, civil and administrative investigations of allegations of wrongdoing regarding HHS programs or HHS beneficiaries. Investigative efforts lead to criminal convictions, civil judgments and settlements, administrative sanctions, and/or civil monetary penalties. Additionally, a small Protective Operations Branch (POB) within OI consists of special agents dedicated solely to protection of the Secretary of HHS in support of domestic and overseas missions.

In law, a settlement is a resolution between disputing parties about a legal case, reached either before or after court action begins. The term "settlement" also has other meanings in the context of law. Structured settlements provide for future periodic payments, instead of a one time cash payment.

The Office of Audit Services (OAS) provides all auditing services for HHS, either through its own resources or by overseeing audit work of others. Audits examine the performance of HHS programs and/or its grantees and contractors in carrying out their respective responsibilities and provide independent assessments of HHS programs and operations.

The Office of Evaluation and Inspections (OEI) conducts management and program evaluations that focus on issues of concern to HHS, the Congress and the public. OEI generally focuses on identifying instances in which the management of large HHS programs can be improved to increase the well-being of beneficiaries or to save Federal health care dollars.

The Office of Counsel to the Inspector General (OCIG) represents OIG in all civil and administrative fraud cases and, in connection with these cases, negotiates and monitors corporate integrity agreements, a compliance agreement in which health care providers or other entities consent to a set of obligations in order to avoid being excluded from participating in any Federal health care program. OCIG also provides guidance to the health care industry to promote compliance with Federal laws and regulations and provides legal support to OIG operations.

A corporate integrity agreement (CIA) is a document outlining the obligations that a company involved in health care in the United States makes with a federal government agency or a state government as part of a civil settlement. On the federal level the Office of Inspector General of the Department of Health and Human Services and the Department of Justice are usually involved, and on the state level, the state attorney general and the state offices involved in Medicaid or Medicare are involved.

The Immediate Office, which includes the Office of External Affairs which handles OIG’s interactions with Congress and the public, is directed by the Inspector General with the assistance of the Principal Deputy Inspector General and his staff.

The Office of Management and Policy provides mission-support services to the Immediate Office of the Inspector General and other OIG components.

HEAT

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a joint task force between OIG, other HHS agencies, and the U.S. Department of Justice (DOJ). Established by President Barack Obama in May 2009, HEAT Strike Force teams target fraud "hot spots" in cities across the country to identify and arrest perpetrators of health care fraud and develop new cutting-edge approaches to combat health care fraud. Under the HEAT initiative, Strike Force teams composed of Special Agents from OIG, DOJ prosecutors, the Federal Bureau of Investigation agents and, in some cases, State and local law enforcement agents collaborate to arrest and convict individuals and entities charged with health care fraud.

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