[Federal Register Volume 62, Number 208 (Tuesday, October 28, 1997)]
[Notices]
[Pages 55810-55815]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-28541]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Office of Inspector General; Statement of Organization, Functions
and Delegations of Authority
This notice amends Part A (Office of the Secretary) of the
Statement of Organization, Functions and Delegations of Authority for
the Department of Health and Human Services (HHS) to reflect recent
changes in Chapter AF, Office of Inspector General (OIG). Chapter AF
was published in its entirety on June 5, 1997 (62 FR 30859).
The statement of organization, functions and delegations of
authority reflects the original transfer of the statutory basis for the
Office of Inspector General from Pub. L. 94-505 to Pub. L. 95-452 (and
made under the Inspector General Act Amendments of 1988, Pub. L. 100-
504), and conforms to and carries out the statutory requirements for
operating the Office of Inspector General. A number of revisions have
been made to reflect the reassignment of functions exercised by the
Office of Enforcement and Compliance to two other components. As a
result, the Office of Investigations will now be responsible for the
development and processing of all program exclusion actions. The Office
of Counsel to the Inspector General will now be responsible for final
decisions regarding administrative sanctions, including program
exclusions and civil money penalties (CMPs), and for developing
corporate integrity and model compliance programs, as well as the
monitoring of corporate integrity agreements. These organizational
changes have been made in an effort to assist the Office of Inspector
General in accomplishing its mission with greater efficiency and
effectiveness.
As amended, Chapter AF now reads as follows:
Section AF.00, Office of Inspector General (OIG)--Mission.
This organization was established by law as an independent and
objective oversight unit of the Department to carry out the mission of
promoting economy, efficiency and effectiveness through the elimination
of waste, abuse and fraud. In furtherance of this mission, the
organization engages in a number of activities:
A. Conducting and supervising audits, investigations, inspections
and evaluations relating to HHS programs and operations.
B. Identifying systemic weaknesses giving rise to opportunities for
fraud and abuse in HHS programs and operations and making
recommendations to prevent their recurrence.
C. Leading and coordinating activities to prevent and detect fraud
and abuse in HHS programs and operations.
D. Detecting wrongdoers and abusers of HHS programs and
beneficiaries so appropriate remedies may be brought to bear.
E. Keeping the Secretary and the Congress fully and currently
informed about problems and deficiencies in the administration of such
programs and operations and about the need for and progress of
corrective action, including imposing sanctions against providers of
health care under Medicare and Medicaid who commit certain prohibited
acts.
In support of its mission, the Office of Inspector General carries
out and maintains an internal quality assurance system and a peer
review system with other Offices of Inspectors General, that include
periodic quality assessment studies and quality control reviews, to
provide reasonable assurance that applicable laws, regulations,
policies, procedures, standards and other requirements are followed;
are effective; and are functioning as intended in OIG operations.
Section AF.10, Office of Inspector General--Organization
There is at the head of the OIG a statutory Inspector General,
appointed by the President and confirmed by the Senate. The Office of
Inspector General consists of six organizational units:
A. Immediate Office of the Inspector General (AFA).
B. Office of Management and Policy (AFC).
C. Office of Evaluation and Inspections (AFE).
D. Office of Counsel to the Inspector General (AFG).
E. Office of Audit Services (AFH).
F. Office of Investigations (AFJ).
Section AF.20, Office of Inspector General--Functions
The component sections which follow describe the specific functions
of the organization.
Section AFA.00, Immediate Office of the Inspector General (IOIG)--
Mission
The Inspector General is directly responsible for meeting the
statutory mission of the OIG as a whole and for promoting effective OIG
internal quality assurance systems, including quality assessment
studies and quality control
[[Page 55811]]
reviews of OIG processes and products. The Office of Inspector General
also plans, conducts and participates in a variety of inter-agency
cooperative projects and undertakings relating to fraud and abuse
activities with the Department of Justice (DOJ), the Health Care
Financing Administration (HCFA) and other governmental agencies.
Section AFA.10, Immediate Office of the Inspector General--Organization
The Immediate Office is comprised of the Inspector General, the
Principal Deputy Inspector General, and an immediate staff.
Section AFA.20, Immediate Office of the Inspector General--Functions
As the senior official of the organization, the Inspector General
supervises the Chief Counsel to the Inspector General and the Deputy
Inspectors General who head the major OIG components. The Inspector
General is appointed by the President, with the advice and consent of
the Senate, and reports to and is under the general supervision of the
Secretary or, to the extent such authority is delegated, the Deputy
Secretary, but does not report to and is not subject to supervision by
any other officer in the Department. In keeping with the independence
intended in the statutory basis for the OIG and its mission, the
Inspector General assumes and exercises, through line management, all
functional authorities related to the administration and management of
the OIG and all mission related authorities stated or implied in the
law or delegated directly from the Secretary.
The Inspector General provides executive leadership to the
organization and exercises general supervision over the personnel and
functions of its major components. The Inspector General determines the
budget needs of the OIG, sets OIG policies and priorities, oversees OIG
operations and provides reports to the Secretary and the Congress. In
this capacity the Inspector General is empowered under the law with
general personnel authority, e.g., selection, promotion, assignment of
employees, including members of the senior executive service. The
Inspector General delegates related authorities as appropriate.
The Principal Deputy Inspector General assists the Inspector
General in the management of the OIG, and during the absence of the
Inspector General, acts as the Inspector General.
Section AFC.00, Office of Management and Policy (OMP)--Mission
This office is responsible for the reporting and legislative and
regulatory review functions required in the law; for formulating and
executing the OIG budget; for managing external affairs; and for
establishing functional policies for the general management of the OIG.
In support of its mission, the office carries out and maintains an
internal quality assurance system. The system includes quality
assessment studies and quality control reviews of OMP processes and
products to ensure that policies and procedures are followed
effectively and function as intended.
Section AFC.10, Office of Management and Policy--Organization
This office is directed by the Deputy Inspector General for
Management and Policy, and comprises the Deputy Inspector General for
OMP and an immediate staff.
Section AFC.20, Office of Management and Policy--Functions
Through the Deputy Inspector General for Management and Policy:
A. The office conducts and coordinates OIG reviews of existing and
proposed legislation and regulations related to HHS programs and
operations to identify their impact on economy and efficiency and their
potential for fraud and abuse. It serves as contact for the press and
electronic media and serves as OIG congressional liaison. The office
prepares or coordinates congressional testimony and confers with
officials in the Office of the Secretary staff divisions on
congressional relations, legislation and public affairs. It develops
and publishes OIG newsletters, recruitment brochures and other
issuances to announce and promote OIG activities and accomplishments.
B. The office coordinates the development of the OIG long-range
strategic plan. It compiles the Semiannual and other legislatively-
mandated reports to the Congress and operates the Executive
Secretariat. It formulates and oversees the execution of the OIG budget
and confers with the Office of the Secretary, the Office of Management
and Budget and the Congress on budget issues. It issues quarterly
grants to States for Medicaid fraud control units. It conducts
management studies and analyses and establishes and coordinates general
management policies for the OIG and publishes those policies in the OIG
Administrative Manual. It serves as OIG liaison to the Office of the
Secretary for personnel issues and other administrative policies and
practices, and on equal employment opportunity and other civil rights
matters. It coordinates internal control reviews for the OIG.
C. The office is responsible for OIG information resources
management (IRM), as defined by the Paperwork Reduction Act, OMB
Circular A-130, the Federal Information Resources Management
regulations, the Computer Security Act of 1987, HHS IRM Circulars, and
by related guidance. The office also provides information technology
support to the OIG through management of its local area networks
nationwide, provision of headquarters computer end-user support, and
support of OIG information systems as required. Through this office,
the Deputy Inspector General for Management and Policy serves as the
OIG Chief Information Officer.
Section AFE.00, Office of Evaluation and Inspections (OEI)--Mission
The Office of Evaluation and Inspections is responsible for
conducting inspections of HHS programs, operations and processes to
identify vulnerabilities, to prevent and detect fraud, waste and abuse,
and to promote economy, efficiency and effectiveness in HHS programs
and operations.
Section AFE.10, Office of Evaluation and Inspections--Organization
This office is directed by the Deputy Inspector General for
Evaluation and Inspections, and comprises the Immediate Office,
including the Deputy Inspector General for OEI and an immediate staff,
and eight regional offices.
Section AFE.20, Office of Evaluation and Inspections--Functions
The office is responsible for carrying out inspections supporting
the OIG mission. The Deputy Inspector General provides general
supervision to the OEI immediate office staff and supervises the
Regional Inspectors General for Evaluation and Inspections who carry
out OEI's mission and activities in assigned geographic areas. The
Immediate Office carries out OEI's mission in headquarters.
A. The immediate office develops OEI's evaluation and inspections
policies, procedures and standards. It manages OEI's human and
financial resources. It develops and monitors OEI's management
information systems. It conducts management reviews within the HHS/OIG
and for other OIG's upon request. The office carries out and maintains
an internal quality assurance
[[Page 55812]]
system. The system includes quality assessment studies and quality
control reviews of OEI processes and products to ensure that policies
and procedures are effective; are followed; and are functioning as
intended.
B. The immediate office manages OEI's work planning process, and
develops and reviews legislative, regulatory and program proposals to
reduce vulnerabilities to fraud, waste and mismanagement. It develops
evaluation techniques and coordinates projects with other OIG and
departmental components. It provides programmatic expertise and
information on new programs, procedures, regulations and statutes to
OEI regional offices. It maintains liaison with other components in the
Department, follows up on implementation of corrective action
recommendations, evaluates the actions taken to resolve problems and
vulnerabilities identified, and provides additional data or corrective
action options, where appropriate.
C. The immediate office provides statistical and data base advice
and services for inspections conducted by the regional offices. It
carries out analyses of large data bases to identify potential areas of
fraud and abuse, and provides technical assistance to the regional
offices for these purposes. It operates a toll-free hotline for the OIG
to permit individuals to call in suspected fraud or waste, refers the
calls for appropriate action by HHS agencies or other OIG components,
and analyzes the body of calls to identify trends and patterns of fraud
and abuse needing attention.
D. The regional offices carry out OEI's mission in the field. The
regional offices evaluate HHS programs and produce the results in
inspection reports. They conduct data and trend analyses of major HHS
initiatives to determine the effects of current policies and practices
on program efficiency and effectiveness. They recommend changes in
program policies, regulations and laws to improve efficiency and
effectiveness, and to prevent fraud, abuse, waste and mismanagement.
They analyze existing policies to evaluate options for future policy,
regulatory and legislative improvements.
Section AFG.00, Office of Counsel to the Inspector General (OCIG)--
Mission
The Office of Counsel to the Inspector General (OCIG) is
responsible for providing all legal services and advice to the
Inspector General, Principal Deputy Inspector General and all the
subordinate components of the Office of Inspector General, in
connection with OIG operations and administration, OIG fraud and abuse
enforcement activities, and OIG activities designed to promote
efficiency and economy in the Department's programs and operations. The
OCIG is also responsible for imposing and litigating CMP and program
exclusion cases within the jurisdiction of the OIG, for the
coordination and disposition of False Claims Act qui tam and criminal,
civil and administrative matters, and for the resolution of voluntary
disclosure and program compliance activities. The OCIG develops models
for corporate integrity, compliance and enforcement programs; monitors
ongoing compliance; and promotes industry awareness of corporate
integrity models.
Section AFG.10, Office of Counsel to the Inspector General--
Organization
The office is directed by the Chief Counsel to the Inspector
General, and the Assistant Inspector General for Legal Affairs. The
office is comprised of the following components:
A. Advice.
B. Civil Recoveries.
C. Administrative Litigation.
D. Industry Guidance.
Section AFG.20, Office of Counsel to the Inspector General--Functions
A. Advice
This office provides legal advice to the various components of the
OIG on legal issues that arise in the exercise of the OIG's
responsibilities under the Inspector General Act of 1978. Such issues
include the scope and exercise of the Inspector General's authorities
and responsibilities; investigative techniques and procedures
(including criminal procedure); the sufficiency and impact of
legislative proposals affecting the OIG; and the conduct and resolution
of investigations, audits and inspections. The office evaluates the
legal sufficiency of OIG recommendations and develops formal legal
opinions to support those recommendations. When appropriate, the office
coordinates formal legal opinions with the HHS Office of the General
Counsel. The office provides legal advice on OIG internal
administration and operations, including appropriations, delegations of
authority, ethics, OIG regulations, personnel matters, the disclosure
of information under the Freedom of Information Act and the
safeguarding of information under the Privacy Act. The office is
responsible for conducting and coordinating litigation activities on
personnel and Equal Employment Opportunity matters and Federal tort
actions involving OIG employees. The office is responsible for the
clearance and enforcement of subpoenas issued by the OIG, and defends
the OIG in litigation matters as necessary.
B. Civil Recoveries
This office oversees all False Claims Act cases, including qui tam
cases, and handles final sign-off on False Claims Act settlements for
the Department, including the amount of restitution and resolution of
the CMP and program exclusion authorities that have been delegated to
the OIG. It coordinates DOJ and U.S. Attorney's offices resource
requests, participates in settlement negotiations and provides
litigation support. Where necessary, the office litigates appeals of
program exclusions imposed in such global cases before the Department
Appeals Board (DAB) and assists DOJ in handling any subsequent appeals
of such cases to the Federal courts. The office coordinates and
resolves all voluntary disclosure cases through: (1) Liaison activities
with DOJ and the U.S. Attorney's office; (2) the disclosure
verification efforts of OAS and OI; and (3) final disposition and sign-
off of the matter. The office, in coordination with other OIG
components, develops both the standards governing the use of program
exclusion authorities, and the criteria for evaluating whether to
impose program exclusions against health care providers. The office is
responsible for developing and maintaining a comprehensive and
coordinated data base on all settled and pending False Claims Act and
CMP cases under its authority.
The Civil Recoveries Branch also develops and monitors corporate
and provider integrity plans adopted as part of settlement agreements,
and develops audit and investigative review standards for monitoring
such plans in cooperation and coordination with other OIG components.
The office resolves breaches of integrity plans through the development
of corrective action plans, on-site reviews, and through the imposition
of sanctions. It serves to increase industry awareness of corporate
compliance integrity issues by promoting voluntary adoption of
corporate compliance plans through speeches, articles, visits and other
liaison activities with governmental and private sector groups, as well
as developing model or best practice recommendations.
C. Administrative Litigation
This office is responsible for determining whether to impose
administrative sanctions, including CMPs within the jurisdiction of the
OIG,
[[Page 55813]]
assessments and program exclusions (with the exception of those handled
by the Civil Recoveries Branch). It effectuates all such health care
mandatory and permissive exclusions under the Social Security Act, and
decides on waiver requests and requests for reinstatement. The office
participates in developing standards governing the imposition of these
exclusion authorities. The office coordinates with the Public Health
Service and DOJ to effectuate repayment agreements with those excluded
individuals who have defaulted on HEAL loans. The office litigates
appeals of program exclusions before the DAB and assists DOJ in
handling any subsequent appeals of such cases to the Federal courts.
The office reviews all cases referred by HCFA under the patient
anti-dumping authority of the Social Security Act, and resolves the
liability for CMPs and program exclusions for hospitals and physicians.
Where appropriate, the office imposes and litigates CMPs and program
exclusions with respect to hospitals and physicians for violations of
the patient anti-dumping statute.
The office imposes and litigates CMPs and assessments under the CMP
law, and ensures that all monetary recoveries are promptly and
accurately reported to the appropriate OIG data base. It represents the
OIG in coordinating all CMP actions initiated by other Federal health
care programs that are authorized to prosecute health care providers.
The office provides guidance and monitors all actions in this area
until completion of these actions.
The Administrative Litigation Branch also has primary
responsibility for developing and promulgating all OIG regulations for
codification into the Code of Federal Regulations, all OIG-related
Federal Register notices, and the review and drafting of legislative
proposals relating to fraud and abuse enforcement activities.
D. Industry Guidance
This office is responsible for drafting and issuing advisory
opinions to the health care industry and members of the public on
whether an activity (or proposed activity) would constitute grounds for
the imposition of a sanction under the anti-kickback statute, the CMP
law or the program exclusion authorities, and on other issues
pertaining to the anti-kickback statute. The office develops and
updates procedures for the submission of requests for advisory opinions
and for determining the fees that will be imposed. The office solicits
and responds to proposals for new regulatory safe harbors to the anti-
kickback statute, modifications to existing safe harbors, and new fraud
alerts. The office consults with, and obtains the concurrence of, DOJ
on all proposed advisory opinions and safe harbors before issuance or
publication. The office provides legal advice to the various components
of the OIG, other offices of the Department, and DOJ concerning matters
involving the interpretation of the anti-kickback statute and other
legal authorities, and assists those components or offices in analyzing
the applicability of the anti-kickback statute to various practices or
activities under review.
Section AFH.00, Office of Audit Services (OAS)--Mission
The Office of Audit Services provides policy direction for and
conducts and oversees comprehensive audits of HHS programs, operations,
grantees and contractors, following generally accepted Government
auditing standards (GAGAS), the Single Audit Act of 1984, applicable
Office of Management and Budget (OMB) circulars and other legal,
regulatory and administrative requirements. This includes investigative
audit work performed in conjunction with other OIG components, directed
toward the prosecution of both civil and criminal cases of program
abuse. It maintains an internal quality assurance system, including
periodic quality assessment studies and quality control reviews, to
provide reasonable assurance that applicable laws, regulations,
policies, procedures, standards and other requirements are followed in
all audit activities performed by, or on behalf of, the Department. In
furtherance of this mission, the organization engages in a number of
activities:
A. The office coordinates and confers with officials of the central
Federal management agencies (OMB, the General Accounting Office (GAO),
the Office of Personnel Management (OPM) and the Department of the
Treasury) on audit matters involving HHS programs and operations. It
provides technical assistance to Federal, State and local investigative
offices on matters concerning the operation of the Department's
programs. It participates in interagency efforts implementing OMB
Circulars A-128 and A-110, which call for use of the single audit
concept for most external audits. It performs audits of activities
administered by other Federal departments, following the system of
audit cognizance administered by OMB. It participates in the
President's Council on Integrity and Efficiency (PCIE) initiatives and
other Government-wide projects. It works with other OIG components on
special assignments and projects. It responds to congressional
oversight interests related to audit matters in the Department.
B. The Office of Audit Services helps HHS operating divisions and
the Office of the Secretary staff divisions to develop policies to
manage grants and procurements and policies to establish indirect cost
rates. It performs pre-award audits of grant or contract proposals to
determine the financial capability of the grantees or contractors and
conducts post-award audits.
C. The office reviews legislative, regulatory and policy proposals
for audit implications. It recommends improvements in the
accountability and integrity features of legislation, regulations and
policy. It prepares reports of audits and special studies for the
Secretary, heads of HHS operating divisions, Regional Directors and
others. It gathers data on unresolved audit findings for the
statutorily required Semiannual Reports to the Congress and for the
Deputy Secretary as Chairman of the Audit Resolution Council. It
conducts follow-up examinations and special analyses of actions taken
on previously reported audit findings and recommendations to ensure
completeness and propriety.
D. The office decides when audits can or may be performed by audit
organizations outside the Department, including those by other Federal
or nonfederal governmental agencies, contractors, or public accounting
firms. It assures that any audit performed by non-OIG auditors complies
with the Government auditing standards established by the Comptroller
General of the United States. It evaluates audits performed for the
Department by outside organizations. It coordinates the development of
the OIG Annual Work Plan and produces the Red Book--a summary of
significant monetary recommendations not yet implemented.
E. The office serves as the focal point for all financial audit
activity within the Department and provides the primary liaison conduit
between the OIG and departmental management. The office provides
overall leadership and direction in carrying out the responsibilities
mandated under the Chief Financial Officers Act relating to financial
statement audits.
Section AFH.10, Office of Audit Services--Organization
The Office of Audit Services comprises the following components:
A. Immediate Office.
[[Page 55814]]
B. Audit Operations and Financial Statement Activities.
C. Health Care Financing Audits.
D. Administrations of Children, Family and Aging Audits.
E. Public Health Audits.
Section AFH.20, Office of Audit Services--Functions
A. Immediate Office of the Deputy Inspector General for Audit Services
This office is directed by the Deputy Inspector General for Audit
Services who carries out the functions designated in the law for the
position, Assistant Inspector General for Auditing. The Deputy
Inspector General for Audit Services is responsible to the Inspector
General for carrying out OIG's audit mission and supervises the
Assistant Inspectors General heading OAS offices described below.
The Immediate Office manages the human and financial resources of
the Office of Audit Services including developing staffing allocation
plans and issuing policy for, coordinating and monitoring all budget,
staffing, recruiting and training activities of the office. Included in
this is the responsibility to track court ordered or agreed-to costs of
audits recouped from health care providers found to have violated
Medicare fraud and abuse program provisions. It maintains a
professional development program for Office of Audit Services staff
which meets the requirements of Government auditing standards. The
office provides liaison with the General Accounting Office. It reviews
all replies to GAO reports to ensure they are responsive, properly
coordinated and representative of HHS policy and advises the Secretary
and other officials about significant findings.
B. Audit Operations and Financial Statement Activities
This office is directed by the Assistant Inspector General for
Audit Operations and Financial Statement Activities. In addition to
directing this office, the Assistant Inspector General supervises the
eight Regional Inspectors General for Audit Services. The office's
principal functions include providing direction and oversight to OAS
through its work planning and quality assurance activities; the direct-
line responsibility for audits of financial statements and financial
related audits, including internal audits of functional areas within
the Department; and directing field audit operations.
1. The office serves as the focal point for all financial statement
and financial related audit activity within the Department and serves
as the primary liaison conduit between the OIG and departmental
management.
2. The office operates an internal quality assurance system that
provides reasonable assurance that applicable laws, regulations,
policies, procedures, standards and other requirements are followed in
all audit activities performed by, or on behalf of, the Department.
3. The office evaluates audit work, including performing quality
control reviews of audit reports, and develops and monitors audit work
plans. It develops audit policy, procedures, standards, criteria and
instructions for all audit activities performed by, on behalf of, or
conforming with departmental programs, grants, contracts or operations
in accordance with GAGAS and other legal, regulatory and administrative
requirements.
4. The office tracks, monitors and reports on audit resolution and
follow-up in accordance with OMB Circular A-50.
5. The office provides oversight for audits of governments,
universities and nonprofit organizations conducted by nonfederal
auditors and those under contract with the OIG (external audit
resources).
6. The office coordinates with the other OIG components in
developing the semiannual report to Congress.
C. Health Care Financing Audits
This office is directed by the Assistant Inspector General for
Health Care Financing Audits. The office conducts programmatic and
fraud and abuse oriented audits of HCFA program operations and oversees
nationwide the audits of the Medicare and Medicaid programs, their
contractors, and providers of services and products. It maintains an
internal quality assurance system, including periodic quality control
reviews, to provide reasonable assurance that applicable laws,
regulations, policies, procedures, standards and other requirements are
followed in all HCFA audit activities performed by, or on behalf of,
the Department.
D. Administrations of Children, Family and Aging Audits
This office is directed by the Assistant Inspector General for
Administrations of Children, Family and Aging Audits. The office
conducts and oversees audits of the operations and programs of the
Administration for Children and Families and the Administration on
Aging, as well as statewide cost allocation plans. It maintains an
internal quality assurance system, including periodic quality control
reviews, to provide reasonable assurance that applicable laws,
regulations, policies, procedures, standards and other requirements are
followed in its audit activities.
E. Public Health Audits
This office is directed by the Assistant Inspector General for
Public Health Audits. The office conducts and oversees audits of the
programs and activities of the public health related agencies,
including the Food and Drug Administration; the National Institutes of
Health; the Health Resources and Services Administration; the Substance
Abuse and Mental Health Services Administration; the Centers for
Disease Control and Prevention; the Agency for Toxic Substances and
Disease Registry; the Indian Health Service and the Surgeon General, as
well as those colleges, universities and nonprofit organizations that
receive research grants from the Federal Government. It maintains an
internal quality assurance system, including periodic quality control
reviews, to provide reasonable assurance that applicable laws,
regulations, policies, procedures, standards and other requirements are
followed in all public health related audit activities performed by, or
on behalf of, the Department.
Section AFJ.00, Office of Investigations (OI)--Mission
The Office of Investigations is responsible for conducting and
coordinating investigative activities related to fraud, waste, abuse
and mismanagement in HHS programs and operations, including wrongdoing
by applicants, grantees, or contractors, or by HHS employees in the
performance of their official duties. It serves as OIG liaison to DOJ
on all matters relating to investigations of HHS programs and
personnel, and reports to the Attorney General when the OIG has
reasonable grounds to believe Federal criminal law has been violated.
The office serves as a liaison with HCFA, State licensing boards and
other outside organizations and entities with regard to exclusion,
compliance and enforcement activities. It works with other
investigative agencies and organizations on special projects and
assignments. In support of its mission, the office carries out and
maintains an internal quality assurance system. The system includes
quality assessment studies and quality control reviews of OI processes
and products to ensure that policies and procedures are followed
effectively, and are functioning as intended.
[[Page 55815]]
Section AFJ.10, Office of Investigations--Organization
The Office of Investigations comprises the following components:
A. Immediate Office.
B. Criminal Investigations.
C. Investigations Policy and Oversight.
Section AFJ.20, Office of Investigations --Functions
A. Immediate Office of the Deputy Inspector General for Investigations
This office is directed by the Deputy Inspector General for
Investigations who is responsible for the functions designated in the
law for the position, Assistant Inspector General for Investigations.
The Deputy Inspector General for Investigations supervises the
Assistant Inspector General and Division Director who head the OI
offices described below.
The Deputy Inspector General for Investigations is responsible to
the Inspector General for carrying out the investigative mission of the
OIG and for leading and providing general supervision to the OIG
investigative component. The Immediate Office coordinates quality
assurance studies to ensure that applicable laws, regulations,
policies, procedures, standards and other requirements are followed in
all investigative activities performed by, or on behalf of, the
Department.
B. Criminal Investigations
This office is directed by the Assistant Inspector General for
Criminal Investigations who supervises a headquarters policy and review
staff and the Regional Inspectors General for Investigations who carry
out investigative activities in their assigned geographic areas.
1. The headquarters staff assists the Deputy Inspector General for
Investigations to establish investigative priorities, to evaluate the
progress of investigations, and to report to the Inspector General on
the effectiveness of investigative efforts. It develops and implements
investigative techniques, programs, guidelines and policies. It
provides programmatic expertise and issues information on new programs,
procedures, regulations and statutes. It directs and coordinates the
investigative field offices.
2. The headquarters staff reviews completed reports of
investigations to ensure accuracy and compliance with guidelines. It
issues the reports to pertinent agencies, management officials and the
Secretary and recommends appropriate debarment actions, administrative
sanctions, CMPs and other civil actions, or prosecution under criminal
law. It identifies systemic and programmatic vulnerabilities in the
Department's operations and makes recommendations for change to the
appropriate managers.
3. The staff provides for the personal protection of the Secretary.
4. The field offices conduct investigations of allegations of
fraud, waste, abuse, mismanagement and violations of standards of
conduct and other investigative matters within the jurisdiction of the
OIG. They coordinate investigations and confer with HHS operating
divisions, staff divisions, OIG counterparts and other investigative
and law enforcement agencies. They prepare investigative and management
improvement reports.
5. The office develops all health care mandatory and permissive
program exclusions, and ensures enforcement of exclusions imposed
through liaison with HCFA, DOJ and other governmental and private
sector entities. It is responsible for developing, improving and
maintaining a comprehensive and coordinated OIG data base on all OIG
exclusion actions, and promptly and accurately reports all exclusion
actions within its authority to the data base. It informs appropriate
regulatory agencies, health care providers and the general public of
all OIG exclusion actions, and is responsible for improving public
access to information on these exclusion actions to ensure that
excluded individuals and entities are effectively barred from program
participation.
C. Investigations Policy and Oversight
This office is directed by the Division Director for Investigations
Policy and Oversight who leads outreach activities to State and local
investigative agencies, and the general management functions of the
Office of Investigations.
1. The office oversees State Medicaid fraud control units and is
responsible for certifying and recertifying these units and for
auditing their Federal funding. The office provides pertinent
information from HHS records to assist Federal, State and local
investigative agencies to detect, investigate and prosecute fraud.
2. The office maintains an automated data and management
information system used by all OI managers and investigators. It
provides technical expertise on computer applications for
investigations and coordinates and approves investigative computer
matches with other agencies.
3. The office develops general management policy for the OI. It
develops and issues instructional media on detecting wrongdoing and on
investigating and processing cases. The office reviews proposed
legislation, regulations, policies and procedures to identify
vulnerabilities and recommends modification where appropriate. It
reviews investigative files in response to Privacy and Freedom of
Information Act requests, and serves as OIG liaison to the Office of
the Secretary for Freedom of Information and Privacy Act requests. It
plans, develops, implements and evaluates all levels of employee
training for investigations, management, support skills and other
functions. It coordinates general management processes, e.g., compiles
reports on the budget, on awards and on other personnel matters for OI
as a whole; implements policies and procedures published in the OIG
Administrative Manual; and processes procurement requests and other
service related actions. It oversees a law enforcement techniques and
equipment program.
Dated: October 6, 1997.
June Gibbs Brown,
Inspector General.
[FR Doc. 97-28541 Filed 10-27-97; 8:45 am]
ILLING CODE 4150-04-P
