[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