Posted and filed under Fraud, FWA, Healthcare.

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.

When we speak to various people in our space looking to engage us in work that involves the OIG, we always inquire what component of the OIG is involved in their query. We are often surprised that many of our colleagues are fully aware of the OIG’s role in fraud, waste and abuse, and have granular knowledge of the OIG’s work, but do not understand the role of each division. Knowing what group or operating division (known as an OpDiv) is involved in your matter can better your understanding, and potentially, where your matter is heading.

There are a few key OpDivs at the OIG: The Office of Investigations (OI), the Office of Audit Services (OAS), the Office of Evaluation and Inspection (OEI), and the Office of Counsel to the Inspector General (OCIG). Each of these OpDivs plays a significant role in the fraud, waste, and abuse continuum.

OI, where our retired OIG resources come from, is the law enforcement arm of the OIG. Like other federal law enforcement agents, OI Special Agents undergo rigorous law enforcement training at the Federal Law Enforcement Training Center (FLETC) in Brunswick, Georgia. The training is conducted over an approximately 12-week period and includes everything from arrest and search warrant techniques to firearms, legal training, and interviewing skills. 

Once completed, graduates move on to specialized training conducted by OI on the very granular nature of healthcare fraud investigations. Our retired OIG Special Agents have served as instructors at FLETC as well the OI internal specialized training. Of course, our retired OI Agents have friends and connections in many OpDivs from their years in the field and training experience.

OAS is comprised of auditors who conduct audits ranging from those derived from the OIG work plan to reviews from data analytic outliers and requests for assistance from OI. These auditors are extremely conversant in CMS policies, and understand the technical aspects of statistical sampling, audit methodology, and reporting to Congress on findings.

OEI is mostly comprised of social scientists and takes a broad view of HHS programs, including policies, potential weaknesses in Medicare and Medicaid policies, and empirical studies of anything that is part of the overall HHS mission. 

OCIG is the legal division of the OIG. Attorneys working in OCIG provide guidance, advice, and support in OIG matters. They are most probably known to the fraud, waste, and abuse community for a few very specific areas: Corporate Integrity Agreements (CIA), Civil Monetary Penalty Law (CMPL) cases, and industry guidance on Stark and Anti-kickback matters. 

All of the above are important to know, if a provider receives a subpoena from the OIG, then knowing who issued the subpoena can go a long way to understanding the potential exposure in a case. For example, if a provider receives a subpoena from the OIG that was issued by the Special Agent in Charge (SAC), it implies that there is a potential investigation implicating the recipient of the subpoena. 

By implication, we merely mean that the recipient may be a witness, subject, or target of an investigation. Our retired OIG resources routinely review these kinds subpoenas, and work to facilitate a better understanding of the nature of the matter at hand. As an attorney, knowing these nuances can help foster a line of communication with the client, the OIG, and work to resolve a matter before it escalates to something more.

Advize Health LLC is a healthcare advisory and consulting company that provides a breadth of healthcare industry services in the payer, provider, and legal communities. Contact our former OIG and Fraud Investigation team by emailing info@advizehealth.com for more information on our Fraud Spotlight series.