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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.
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 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.
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.
The Inspector General Act of 1978 is a United States federal law defining a standard set of Inspector General offices across several specified departments of the U.S. federal government.
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.
The United States Congress is the bicameral legislature of the Federal Government of the United States. The legislature consists of two chambers: the House of Representatives and the Senate.
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.
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.
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.
Barack Hussein Obama II is an American attorney and politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party, he was the first African American to be elected to the presidency. He previously served as a U.S. senator from Illinois from 2005 to 2008.
The Federal Bureau of Investigation (FBI) is the domestic intelligence and security service of the United States, and its principal federal law enforcement agency. Operating under the jurisdiction of the United States Department of Justice, the FBI is also a member of the U.S. Intelligence Community and reports to both the Attorney General and the Director of National Intelligence. A leading U.S. counter-terrorism, counterintelligence, and criminal investigative organization, the FBI has jurisdiction over violations of more than 200 categories of federal crimes.
HHS-OIG agents qualify with, and field the Glock 23 and Glock 27 pistols as well as the LWRC M6 rifle on a quarterly basis. Agents conduct regular refresher training in law enforcement defensive and arrest tactics.
The Animal and Plant Health Inspection Service (APHIS) is an agency of the United States Department of Agriculture (USDA) based in Riverdale, Maryland responsible for protecting animal health, animal welfare, and plant health. APHIS is the lead agency for collaboration with other agencies to protect U.S. agriculture from invasive pests and diseases. APHIS is the National Plant Protection Authority for the U.S. government, and the agency's head of veterinary services is Chief Veterinary Officer of the United States.
A Special Agent, in the United States, is usually a criminal investigator or detective for a federal or state government, that primarily serves in investigatory positions. Additionally, many federal and state "Special Agents" operate in "criminal intelligence" based roles as well. Within the US federal law enforcement system, dozens of federal agencies employ federal law enforcement officers, each with different criteria pertaining to the use of the titles Special Agent and Agent.
In the United States, the Office of Inspector General (OIG) is a generic term for the oversight division of a federal or state agency aimed at preventing inefficient or illegal operations within their parent agency. Such offices are attached to many federal executive departments, independent federal agencies, as well as state and local governments. Each office includes an inspector general and employees charged with identifying, auditing, and investigating fraud, waste, abuse, embezzlement and mismanagement of any kind within the executive department.
The Defense Criminal Investigative Service is the criminal investigative arm of the Office of the Inspector General, U.S. Department of Defense. DCIS protects military personnel by investigating cases of fraud, bribery, and corruption; preventing the illegal transfer of sensitive defense technologies to proscribed nations and criminal elements; investigating companies that use defective, substandard, or counterfeit parts in weapons systems and equipment utilized by the military; and stopping cyber crimes and computer intrusions.
The United States Postal Inspection Service (USPIS) is the law enforcement arm of the United States Postal Service. Its jurisdiction is defined as "crimes that may adversely affect or fraudulently use the U.S. Mail, the postal system or postal employees." The mission of the U.S. Postal Inspection Service is to support and protect the U.S. Postal Service, its employees, infrastructure, and customers by enforcing the laws that defend the nation's mail system from illegal or dangerous use.
The United States Postal Service Office of Inspector General (OIG) of the United States Postal Service was created by federal statute in 1996, assuming internal oversight duties over the United States Postal Service. The Inspector General of the United States Postal Service, who is independent of postal management, is appointed by and reports to the Board of Governors of the United States Postal Service. The current Inspector General is Tammy L. Whitcomb.
The Office of Inspector General for the Department of State (OIG) is an independent office within the U.S. Department of State with a primary responsibility to prevent and detect waste, fraud, abuse, and mismanagement. OIG inspects more than 270 embassies, diplomatic posts, and international broadcasting installations throughout the world to determine whether policy goals are being achieved and whether the interests of the United States are being represented and advanced effectively.
The Office of the Inspector General (OIG) for the Department of Justice (DOJ) is the Office of the Inspector General specific to the United States Department of Justice that is responsible for conducting nearly all of the investigations of DOJ employees and programs. The office has several hundred employees, reporting to the Inspector General. Michael E. Horowitz has held the post since 2012.
The Department of Homeland Security Office of Inspector General was established along with the Department of Homeland Security itself in 2002 by the Homeland Security Act. Its website describes its mission as "supervis[ing] independent audits, investigations, and inspections of the programs and operations of DHS, and recommends ways for DHS to carry out its responsibilities in the most effective, efficient, and economical manner possible."
In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.
The U.S.Department of Transportation Office of Inspector General is one of the Inspector General offices created by the Inspector General Act of 1978. The Inspector General for the Department of Transportation, like the Inspectors General of other federal departments and agencies, is charged with monitoring and auditing department programs to combat waste, fraud, and abuse.
The NASA Office of Inspector General is the inspector general office in the National Aeronautics and Space Administration, the space agency of the United States. The OIG's stated mission is to "prevent and detect crime, fraud, waste, abuse, and mismanagement and promote efficiency, effectiveness, and economy throughout NASA."
The federal government of the United States empowers a wide range of law enforcement agencies to maintain law and public order related to matters affecting the country as a whole.
The California Department of Justice is both a statewide investigative law enforcement agency and state legal department in the California executive branch under the elected leadership of the California Attorney General (AG) which carries out complex criminal & civil investigations, prosecutions, and other legal services throughout the state.
Frank E. Sheeder III is an American lawyer and thought leader in health care enforcement, compliance, and healthcare fraud, waste and abuse litigation.
The Department of Defense Inspector General is an independent, objective agency that provides oversight related to the programs and operations of the United States Department of Defense (DoD). DoD IG was created in 1982 as an amendment to the Inspector General Act of 1978. It is the largest office of the Inspector-General in the United States.
Daniel Ronald Levinson has headed the Office of Inspector General for the U.S. Department of Health and Human Services (HHS) since September 8, 2004. HHS is among the largest departments in the federal government, encompassing Medicare, Medicaid, public health, medical research, food and drug safety, welfare, child and family services, disease prevention, Indian health, and mental health services. It also exercises leadership responsibilities in public health emergency preparedness and combating bio-terrorism.
Special Inspector General for Afghanistan Reconstruction (SIGAR) is the U.S. government's leading oversight authority on Afghanistan reconstruction. Congress created the Office of the Special Inspector General for Afghanistan Reconstruction to provide independent and objective oversight of the Afghanistan Reconstruction funds. Under the authority of Section 1229 of the National Defense Authorization Act for Fiscal Year 2008, SIGAR conducts audit, inspections, and investigations to promote efficiency and effectiveness of reconstruction programs, and to detect and prevent waste, fraud, and abuse of taxpayer dollars. SIGAR also has a hotline that allows individuals to report suspected fraud.
The Division of Select Agents and Toxins (DSAT) of the Centers for Disease Control and Prevention is responsible for the Select Agent Program and the Etiologic Agent Import Permit Program. They inspect the laboratories of more than 300 organizations approved to use and transfer select agents, and put regulations in place to minimize risk in the use of these bacterial agents and toxins.