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The Office of Inspector General (OIG)

By:  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Published:  April 14th, 2017

The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect the well-being of all Americans. The OIG cconducts criminal, civil, and administrative investigations of allegations of wrongdoing regarding HHS programs or HHS beneficiaries.

The purpose is to identify opportunities to improve program economy and to protect the integrity of the U.S. Department of Health and Human Services (HHS) program. The OIG will hold accountable anyone not meeting program requirements, or anyone that violates Federal healthcare program laws. Federal and State agencies will generally send referrals to the OIG for exclusion. The OIG states “In 2016 OIG excluded 3,635 individuals and entities from participation in the Federal healthcare programs.”

A Federal healthcare program is defined as a plan or program providing health benefits that is funded by the United States Government or a State healthcare program (this does not include Federal Employees Health Benefits).

The OIG web site reports, “HHS OIG is the largest Inspector General’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste, and abuse and to improving the efficiency of HHS programs.”

The Office of Audit Services (OAS) provides all auditing services for HHS.

The Office of Evaluation and Inspections (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.

Office of Counsel to the Inspector General (OCIG) represents OIG in all civil and administrative fraud cases.

Acronyms and Departments of the OIG

OIG

Office of Inspector General

HHS

U.S. Department of Health & Human Services (HHS)

OAS

The Office of Audit Services (OAS)

OEI

The Office of Evaluation and Inspections (OEI)

OI

The Office of Investigations (OI)

OCIG

The Office of Counsel to the Inspector General (OCIG)

EM

Executive Management (EM)

LEIE

List of Excluded Individuals and Entities (LEIE)

Understanding OIG’s Program Exclusions

Any individual or entity can be excluded, and reinstatement is NOT automatic. If and entity is excluded and wishes to participate again they must apply for reinstatement.

https://oig.hhs.gov/compliance/provider-compliance-training/files/HandoutExclusionTips508.pdf

Exclusions list (LEIE)

With the authority to exclude individuals and entities from Federally funded health care programs, anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties.

OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. For a complete list of mandatory and permissive exclusions, visit the Exclusion list of authorities. https://oig.hhs.gov/exclusions/authorities.asp

Online Searchable Database

Search for multiple individual, a single entity, or multiple entities.

https://exclusions.oig.hhs.gov/

Download the LEIE Database

https://oig.hhs.gov/exclusions/exclusions_list.asp

OIG Most Wanted Fugitives

https://oig.hhs.gov/fraud/fugitives/index.asp

OIG 2017 Work Plan

The OIG work plan will set forth projects that will be addressed during the fiscal year by the office of Audit Services (OAS). Work planning is a constantly evolving process and is updated throughout the year in order to meet any priorities in an effort to anticipate and respond to emerging issues with current resources available. Due to a continual update on the Work Plan, there are not status reports or the progress of reports. Contact public.affairs@oig.hhs.gov for questions.

https://oig.hhs.gov/reports-and-publications/archives/workplan/2017/HHS%20OIG%20Work%20Plan%202017.pdf

The OIG Compliance Plan Guidance

Voluntary compliance plan guidance is posted on the Federal register from the OIG and made available to the public. For instance, the Federal Register notices issued compliance program guidance for Individual and Small Group Physician Practices developed by the OIG and are made available to the public and developed as voluntary compliance plan guidance. With detailed information on the elements for an effective compliance program, the OIG has identified fundamental elements to an effective compliance program for different types of entities and risk areas and assessments.

Other related links

http://www.oig.hhs.gov


References:

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