[Federal Register Volume 59, Number 110 (Thursday, June 9, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-14051]


[[Page Unknown]]

[Federal Register: June 9, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
 Office of Inspector General

 

Statement of Organization, Functions, and Delegations of 
Authority

AGENCY: Office of the Secretary, HHS, Office of Inspector General.

ACTION: Notice.

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SUMMARY: 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 to reflect organizational 
changes in chapter AF, Office of Inspector General (OIG).

EFFECTIVE DATE: This notice is effective on June 9, 1994.

FOR FURTHER INFORMATION CONTACT:
Joel J. Schaer, (202) 619-0089.

SUPPLEMENTARY INFORMATION: Chapter AF, the Office of Inspector 
General's Statement of Organization, Functions and Delegations of 
Authority Chapter AF, published in the Federal Register on November 7, 
1989 (54 FR 46775), is amended as follows:
    1. Section AF.10, Office of Inspector General--Organization, is 
revised to read as follows:

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 the Principal Deputy Inspector General (AFA1).
    C. Office of Audit Services (AFH).
    D. Office of Investigations (AFJ).
    E. Office of Evaluation and Inspections (AFE).
    F. Office of Civil Fraud and Administrative Adjudication (AFL).
    2. Section AFJ.10, Office of Investigations--Organization, is 
revised to read as follows:

 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.
    3. Section AFJ.20, Office of Investigations--Functions, is revised 
by deleting existing paragraph C., and by redesignating existing 
paragraph D. to read as the new paragraph C.
    4. A new section AFL.00, Office of Civil Fraud and Administrative 
Adjudication (OCFAA)--Mission, is added to read as follows:

 Section AFL.00  Office of Civil Fraud and Administrative Adjudication 
(OCFAA)--Mission

    The Office of Civil Fraud and Administrative Adjudication is 
responsible for protecting the government-funded health care programs 
and deterring fraudulent conduct by health care providers through the 
negotiation and imposition of civil money penalties, assessments and 
program exclusions. It works with various investigative agencies and 
organizations in the development of health care civil fraud cases, 
including qui tam cases referred by the Department of Justice.
    5. A new section AFL.10, Office of Civil Fraud and Administrative 
Adjudication--Organization, is added to read as follows:

Section AFL. 10  Office of Civil Fraud and Administrative 
Adjudication--Organization

    The Office of Civil Fraud and Administrative Adjudication comprises 
the Assistant Inspector General and an immediate staff.
    6. A new section AFL.20, Office of Civil Fraud and Administrative 
Adjudication--Functions, is added to read as follows:

 Section AFL.20  Office of Civil Fraud and Administrative 
Adjudication--Functions

    This office is directed by the Assistant Inspector General for 
Civil Fraud and Administrative Adjudication.
    1. The office provides policy guidance and technical expertise to 
the Department, other Federal agencies, carriers, intermediaries, 
providers and private organizations on civil fraud law and regulations, 
penalties, sanctions and other remedies. It maintains liaison with the 
Department of Justice on the civil fraud aspects of health care and 
other HHS investigations.
    2. The office coordinates and helps investigate matters arising 
under the Program Fraud Civil Remedies Act, the Civil Monetary 
Penalties Law, and the Medicare and Medicaid Patient and Program 
Protection Act, including alleged misconduct by health care entities 
and others under Medicare and the State health care programs. It 
assists the Department of Justice to investigate and evaluate civil 
fraud lawsuits brought under the qui tam provisions of the Federal 
False Claims Act and related statutes.
    3. The office directs and coordinates medical reviews on civil 
money penalty and exclusion cases to ensure that findings and 
conclusions are correct and supported by medical records. It evaluates 
proposals to exclude individuals and entities from participation in the 
Department's health care programs. It conducts administrative reviews 
on proposed exclusions and provides written reports incident to the 
reviews. It negotiates, implements and monitors settlement agreements 
and exclusion requirements and, in cases of default, implements penalty 
provisions. It assists in investigations related to requests for 
reinstatement by excluded individuals and entities, and conducts 
administrative reviews in accordance with regulations, and adjudicates 
the requests for reinstatement. It maintains indices of sanctioned 
individuals and entities and prepares reports of sanction and penalty 
activities for distribution.

    Dated: May 27, 1994.
June Gibbs Brown,
Inspector General.
[FR Doc. 94-14051 Filed 6-8-94; 8:45 am]
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