Office of Inspector General Administrative Authorities

Abstract

The Office of the Inspector General for the Department of Health and Human Services (“OIG”) is a central player in healthcare fraud and abuse enforcement. OIG employs special agents to conduct civil and criminal investigations and lawyers that coordinate closely with DOJ in healthcare fraud prosecutions and FCA lawsuits. OIG also has independent enforcement power under its exclusion authority and the Civil Monetary Penalties Statute (“CMPS”). OIG has both mandatory exclusion and permissive exclusion authority. Mandatory exclusion is required generally for felony offenses related to healthcare fraud, controlled substances, patient fraud, or other program related crimes. Permissive exclusion is authorized for a variety of offenses, but is often exercised in conjunction with FCA settlements and judgments. Exclusion can apply to both individuals and business entities. OIG also may levy monetary penalties under the CMPS for a variety of offenses related to federal healthcare programs, including many that are also actionable under the FCA or AKS. Civil penalties and exclusion decisions are subject to both an administrative review process and review by a United States Circuit Court of Appeals.