Medicare_Carriers_Manual / 14002 / 14002.4_OFFICE_OF_INSPECTOR_GENERAL.-

Why This Topic Matters

Understanding the roles of OIG offices helps providers, compliance staff, and auditors recognize how Medicare integrity issues are handled at a federal level. The article provides background on the organizations involved in investigations, audits, sanctions, and referrals.

Article Sections

1. Overview of OIG responsibilities

   Introduces the Office of Inspector General’s general role in investigating suspected fraud or abuse and conducting audits and inspections of federal health program activities.

2. A. Office of Civil Fraud and Administrative Adjudication (OCFAA)

   Describes the office’s coordination role in administrative fraud and exclusion matters and its interaction with other HHS and oversight entities.

3. B. Office of Investigations

   Summarizes the investigative function within OIG, including the types of cases handled and the office’s relationship with prosecuting authorities and administrative review pathways.

4. C. Office of Audit Services

   Covers the audit function, including audit support for program integrity efforts and coordination with investigative activities.