[Federal Register Volume 62, Number 108 (Thursday, June 5, 1997)]
[Notices]
[Pages 30859-30865]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14611]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
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 last published in its entirety on May 13, 1996 (61 FR 22059).
The statement of organization, functions and delegations of
authority reflects the original transfer of the statutory basis for the
Office of Inspector General from Public Law 94-505 to Public Law 95-452
(and made under the Inspector General Act Amendments of 1988, Public
Law 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 consolidation of the Inspector
General Division of the Office of the General Counsel and the Office of
Litigation Coordination into the new Office of Counsel to the Inspector
General (OCIG), and the incorporation of OCIG into the OIG
organizational structure. In addition, several technical changes have
been made to reflect revised component functions and duties in
accordance with new or amended authorities and responsibilities
resulting from the Health Insurance Portability and Accountability Act
of 1996 (Public Law 104-191). These organizational changes have been
made in an effort to assist the
[[Page 30860]]
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 seven 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 Enforcement and Compliance (AFF).
E. Office of Counsel to the Inspector General (AFG).
F. Office of Audit Services (AFH).
G. 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 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
[[Page 30861]]
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 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 AFF.00, Office of Enforcement and Compliance (OEC)--
Mission. The Office of Enforcement and Compliance is responsible for
the imposition of those mandatory and permissive program exclusions and
civil money penalty (CMP) and assessment actions not handled by the
Office of Counsel to the Inspector General (OCIG), Civil Recoveries
Branch. 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 develops models
for corporate integrity, compliance and enforcement programs; monitors
ongoing compliance, exclusion, enforcement activities and HCFA
suspension agreements; and promotes industry awareness of corporate
integrity and enforcement agreements developed by the OIG.
Section AFF.10, Office of Enforcement and Compliance--Organization.
This office is directed by the Deputy Inspector General for Enforcement
and Compliance, and comprises the Deputy Inspector General for OEC and
an immediate staff.
Section AFF.20, Office of Enforcement and Compliance--Functions.
Through the Deputy Inspector General for Enforcement and Compliance:
A. The office develops, coordinates and effectuates all health care
mandatory and permissive exclusions, with the exception of those
handled by the OCIG, Civil Recoveries Branch. The office develops
standards governing the imposition of the mandatory and permissive
exclusion authorities within the scope of its responsibility, and
develops criteria for evaluating when it will impose such permissive
exclusions against health care providers. It reviews all applications
for readmission to program participation for purposes of determining
whether an excluded provider has demonstrated the ability to comply
with program requirements; and ensures enforcement of exclusions
imposed through liaison with HCFA, DoJ and other governmental and
private sector entities. The office coordinates with the Public Health
Service to effectuate repayment agreements with those excluded
individuals who have defaulted on HEAL loans.
B. The office 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.
[[Page 30862]]
C. The office imposes CMPs and other assessments in accordance with
the CMP law on those cases not handled by the OCIG, Civil Recoveries
Branch, and ensures that all monetary recoveries are promptly and
accurately reported to the appropriate OIG data base.
D. The office monitors corporate and provider compliance 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. It resolves breaches of
compliance plans through the development of corrective action plans,
on-site reviews, and when appropriate, refers material breaches of
compliance plans to the OCIG, Civil Recoveries Branch for potential
sanctioning.
E. The office serves to increase industry awareness of corporate
compliance issues by proactively 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 to be utilized by
the health care industry.
F. The office 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.
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 litigating civil money penalty (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 involving the Department of Justice
(DoJ), and for the resolution of voluntary disclosure and program
compliance activities.
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, in coordination with the HHS Office of the
General Counsel, to support those recommendations. 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. It coordinates DOJ resource
requests, participates in settlement negotiations and provides
litigation support. It coordinates the Department's response to all
settlement proposals in cases involving DOJ, including the amount of
restitution and resolution of the selected CMP and program exclusion
liability. Where necessary, the office litigates appeals of program
exclusions imposed in such 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 in cases
involving other Federal agencies, including DOJ, and the criteria for
evaluating whether to impose program exclusions against health care
providers in such cases. It is responsible for ensuring that all
program exclusion actions not handled by OEC are promptly and
accurately reported to the appropriate OIG data base. 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.
C. Administrative Litigation. This office is responsible for
providing legal advice to OEC concerning the legal sufficiency of
proposed program exclusions, issues relating to the scope and effect of
program exclusions, and the reinstatement of excluded persons or
entities. The office assists OEC in developing standards governing the
imposition of program exclusions. The office litigates appeals of
program exclusions imposed by OEC before the DAB and assists DOJ in
handling any subsequent appeals of such cases to the Federal courts.
The office reviews all patient anti-dumping cases referred by the
Health Care Financing Administration, makes recommendations regarding
the handling of these cases, and negotiates settlements with hospitals
and physicians of their liability for CMPs and program exclusions.
Where appropriate, the office litigates CMPs and program exclusions
imposed on hospitals and physicians for violations of the patient anti-
dumping statute. The office also reviews, negotiates settlements, and
litigates other CMP cases that have been referred by OEC. In addition,
the office provides legal advice to OEC on matters involving the
development and monitoring of corporate compliance plans, the
resolution of breaches of such plans, and the development of corrective
action plans. The office also has primary responsibility for developing
and promulgating all OIG sanction and interpretative 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
[[Page 30863]]
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 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. 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 summaries of both (1) the Orange
Book--a summary of unimplemented program and management improvements
recommended--and (2) 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.
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
[[Page 30864]]
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 Alcohol, Drug Abuse, and Mental Health
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.
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.
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 Inspectors General
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
[[Page 30865]]
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.
C. Investigations Policy and Oversight. This office is directed by
the Assistant Inspector General 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. It
manages the HHS Hotline to receive complaints and allegations of fraud,
waste and abuse, and to refer the information for investigation, audit,
program review, or other appropriate action. It coordinates with the
GAO hotline and hotlines from other agencies.
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. It plans, develops, implements and evaluates
all levels of employee training for investigations, management, support
skills and other functions, and serves as OIG liaison to the Office of
the Secretary for Freedom of Information and Privacy Act requests. 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.
Dated: May 15, 1997.
June Gibbs Brown
Inspector General.
[FR Doc. 97-14611 Filed 6-4-97; 8:45 am]
BILLING CODE 4150-04-P
