[Federal Register Volume 81, Number 50 (Tuesday, March 15, 2016)]
[Notices]
[Pages 13807-13810]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-05714]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General

[OIG-1206-N]


Statement of Organization, Functions, and Delegations of 
Authority

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

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SUMMARY: This notice replaces all language in 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), 
Office of Inspector General (OIG) (70 FR 20147, as amended April 18, 
2005; as last amended at 73 FR 7568, dated February 8, 2008).
    The statement of organization, functions, and delegations of 
authority conforms to and carries out the statutory requirements for 
operating OIG. The organizational changes reflected in this notice are 
primarily to realign the functions within OIG to better reflect the 
current work environment and priorities, and to more clearly delineate 
responsibilities for the various activities within OIG's offices. In 
addition, this notice removes all of Chapter A and establishes Chapter 
Q.
    OIG was established by law as an independent and objective 
oversight unit of the Department to carry out the mission of preventing 
fraud and abuse and promoting economy, efficiency and effectiveness of 
HHS programs and operations. In furtherance of this mission, the 
organization:
    A. Conducts and supervises audits, investigations, evaluations and 
inspections relating to HHS programs and operations.
    B. Identifies systemic weaknesses giving rise to opportunities for 
fraud and abuse in HHS programs and operations and makes 
recommendations to prevent their recurrence.
    C. Leads and coordinates activities to prevent and detect fraud and 
abuse in HHS programs and operations.
    D. Detects wrongdoers and abusers of HHS programs and beneficiaries 
so appropriate remedies may be brought to bear, including imposing 
administrative sanctions against providers of health care under 
Medicare and Medicaid who commit certain prohibited acts.
    E. Keeps the Secretary and Congress fully and currently informed 
about problems and deficiencies in the administration of HHS programs 
and operations and about the need for and progress of corrective 
action.
    In addition, OIG works with the Department of Justice (DOJ), on 
behalf of the Secretary, to operate the Health Care Fraud and Abuse 
Control Program. In accordance with authority enacted in its annual 
appropriations, OIG also provides protection services to the Secretary 
and conducts criminal investigations of violations of Federal child 
support provisions.
    In support of its mission, OIG carries out and maintains an 
internal quality assurance system and a peer review system with other 
Offices of Inspectors General, 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, are effective, and are functioning as 
intended in OIG operations.

Section Q, Office of Inspector General--Organization

    There is at the head of OIG a statutory Inspector General, 
appointed by the President and confirmed by the Senate. This office 
consists of six organizational units:

A. Immediate Office of the Inspector General (QA)
B. Office of Management and Policy (QC)
C. Office of Evaluation and Inspections (QE)
D. Office of Counsel to the Inspector General (QG)
E. Office of Audit Services (QH)
F. Office of Investigations (QJ)

Section Q, Office of Inspector General--Functions

    The component sections that follow describe the specific functions 
of the organization.

Section Q.00, Immediate Office of the Inspector General--Mission

    The Immediate Office of the Inspector General is directly 
responsible for meeting the statutory mission of 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 also plans, conducts and participates in a 
variety of interagency cooperative projects and undertakings relating 
to fraud and abuse with the DOJ, the Centers for Medicare & Medicaid 
Services (CMS) and other governmental agencies, and is responsible for 
the reporting and legislative and regulatory review functions required 
by the Inspector General Act.

Section QA.10, Immediate Office of the Inspector General--Organization

    The Immediate Office is comprised of the Inspector General, the 
Principal Deputy Inspector General, Chief of Staff,

[[Page 13808]]

several technical advisors, including the Chief Medical Officer, and 
staff.

Section QA.20, Immediate Office of the Inspector General--Functions

    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 conferred by the Inspector General Act, 
the Inspector General assumes and exercises, through line management, 
all functional authorities related to the administration and management 
of 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 OIG, sets OIG policies and priorities, oversees OIG 
operations and provides reports to the Secretary and Congress. By 
statute, the Inspector General exercises general personnel authority, 
e.g., selection, promotion, and 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 
OIG, and during the absence of the Inspector General, acts as the 
Inspector General. The Principal Deputy Inspector General supervises 
the Chief Counsel to the Inspector General, the Deputy Inspectors 
General, who head the major OIG components, as well as the Chief of 
Staff.

Section QC.00, Office of Management and Policy--Mission

    The Office of Management and Policy (OMP) provides management, 
guidance, and resources in support of OIG.

Section QC.10, Office of Management and Policy--Organization

    The office is directed by the Deputy Inspector General for 
Management and Policy, who, aided by Assistant Inspectors General, 
assures that OIG has the financial and administrative resources 
necessary to fulfill its mission. This office carries out its 
responsibilities through headquarters functions.

Section QC.20, Office of Management and Policy--Functions

    The staffs within OMP are responsible for formulating and executing 
the budget, developing policy, managing information technology, human 
resources, executive resources, OIG procurement activities and OIG 
physical space. OMP also executes and maintains an internal quality 
assurance system, which includes quality control reviews of OMP 
processes and products to ensure that OIG policies and procedures are 
followed and function as intended. Additionally, the office leads OIG's 
congressional and regulatory functions; media and public 
communications; coordinates strategic planning and mandated Inspector 
General reporting, including Work Plans and Semi-Annual Reports to 
Congress; and responds to all requests made under the Freedom of 
Information Act.
    Finally, the office leads and coordinates OIG's data analysis 
management and organizational performance management activities.

Section QE.00, Office of Evaluation and Inspections--Mission

    The Office of Evaluation and Inspections (OEI) is responsible for 
conducting in-depth evaluations of HHS programs, operations, and 
processes to identify vulnerabilities and recommend corrective action; 
to prevent and detect fraud and abuse; and to promote efficiency and 
effectiveness in HHS programs and operations. OEI conducts its work in 
accordance with the Quality Standards for Inspection and Evaluation 
issued by the Council of the Inspectors General on Integrity and 
Efficiency.

Section QE.10, Office of Evaluation and Inspections--Organization

    This office is directed by the Deputy Inspector General for OEI 
who, aided by Assistant Inspectors General, is responsible for carrying 
out OIG's responsibilities to evaluate the effectiveness and efficiency 
of HHS programs and operations. The office is comprised of headquarters 
and regional functions.

Section QE.20, Office of Evaluation and Inspections--Functions

    OEI is responsible for conducting evaluations of HHS programs; 
conducting data and trend analysis; and recommending changes in 
programs, procedures, policies, regulations, and legislation. The 
Office develops evaluation policies, procedures, techniques and 
guidelines to be followed by all OEI staff in conducting evaluations. 
The office maintains an internal quality assurance program. OEI also 
oversees the activities of State Medicaid Fraud Control Units (MFCUs) 
to ensure the MFCUs' compliance with Federal grant regulations, 
administrative rules, and performance standards for the purpose of 
certifying or recertifying the MFCUs annually.
    The office also maintains automated data and management information 
systems used by all OEI employees, a quality assurance/peer review 
program and policy and procedure manuals.

Section QG.00, Office of Counsel to the Inspector General--Mission

    In accordance with section 3(g) of the Inspector General Act (5 
U.S.C. App. Sec.  3(g)), the Office of Counsel to the Inspector General 
(OCIG) provides all legal advice to OIG and represents OIG in 
administrative litigation. OCIG proposes and litigates civil money 
penalty (CMP) and program exclusion cases within the jurisdiction of 
OIG. It coordinates False Claims Act matters involving HHS programs and 
resolves voluntary disclosure cases. OCIG develops guidance to assist 
providers in establishing compliance programs; monitors ongoing 
compliance of providers subject to integrity agreements; and promotes 
industry awareness through advisory opinions, fraud alerts, and special 
advisory bulletins.

Section QG.10, Office of Counsel to the Inspector General--Organization

    The office is directed by the Chief Counsel to the Inspector 
General and aided by Assistant Inspectors General. The office carries 
out its responsibilities through headquarters functions.

Section QG.20, Office of Counsel to the Inspector General--Functions

    The office provides legal advice to OIG on issues that arise in the 
exercise of 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 OIG and HHS; and the conduct 
and resolution of investigations, audits and inspections. The office 
evaluates the legal sufficiency of OIG findings and recommendations and 
develops formal legal opinions to support these findings and 
recommendations. The office provides legal advice on OIG internal 
administration and operations, including appropriations, delegations of 
authority, OIG regulations, personnel matters, the disclosure of 
information under the Freedom of Information Act,

[[Page 13809]]

and the safeguarding of information under the Privacy Act and serves as 
OIG's Deputy Ethics Officer. The office is responsible for the 
clearance and enforcement of subpoenas issued by OIG.
    The office represents OIG in administrative litigation and related 
appeals. This includes representing OIG in personnel and Equal 
Employment Opportunity matters; and coordinating OIG's representation 
in Federal tort actions involving OIG employees.
    The office also determines whether to propose or implement 
administrative sanctions, including CMPs and assessments within the 
jurisdiction of OIG. The office litigates and resolves all appealed or 
contested exclusions from participation in Federal health care programs 
under the Social Security Act. In coordination with DOJ, the office 
represents HHS in all False Claims Act cases, including qui tam cases, 
and is responsible for final approval of civil False Claims Act 
settlements for the Department, including the resolution of the program 
exclusion authorities that have been delegated to OIG.
    The office, in conjunction with the Office of Investigations, 
coordinates resolution of all voluntary and mandatory disclosure under 
the OIG Provider Self-Disclosure Protocol, the contractor self-
disclosure requirement and otherwise. The office develops and monitors 
corporate and individual integrity agreements adopted in connection 
with settlement agreements, conducts on-site reviews, and develops 
audit and investigative review standards for monitoring such integrity 
agreements in cooperation with other OIG components. The office 
resolves breaches of integrity agreements through the development of 
corrective action plans and through the imposition of sanctions.
    Finally, the office issues advisory opinions to the health care 
industry and members of the public on whether a current 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. The office develops procedures for submitting and 
processing 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 DOJ on proposed advisory opinions and safe harbors before issuance 
or publication. The office provides legal advice to the components of 
OIG, other HHS offices 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 particular practices or 
activities under review.

Section QH.00, Office of Audit Services--Mission

    The Office of Audit Services (OAS) is responsible for protecting 
the integrity of HHS operations and programs by conducting audits that 
identify and report ways to improve the economy, efficiency, and 
effectiveness of operations and services to beneficiaries of HHS 
programs, and help reduce fraud, waste, abuse, and mismanagement. OAS 
conducts audits and oversees audit work performed by others. It 
conducts its work in accordance with Government Auditing Standards and 
follows applicable legal, regulatory, and administrative requirements.

Section QH.10, Office of Audit Services--Organization

    The office is directed by the Deputy Inspector General for Audit 
Services who, aided by Assistant Inspectors General, performs the 
functions designated in Section 3(d)(1)A of the Inspector General Act) 
for the position of Assistant Inspector General for Auditing. The 
office is comprised of headquarters and regional functions and also 
includes a designated Whistleblower Protection Ombudsman, and the 
functions thereof, as required by law (section 3(d)(1)C of the 
Inspector General Act).

Section QH.20, Office of Audit Services--Functions

    OAS establishes audit priorities; performs audits; oversees the 
progress of audits; coordinates on bodies of work with stakeholders; 
recommends changes in program policies, regulations, and legislation to 
prevent fraud, waste, and abuse and improve programs and operations; 
and reports on the impact of audit work. The office develops audit 
policies, procedures, techniques, and guidelines to be followed by all 
OAS staff in conducting audits. OAS maintains an internal quality 
assurance program, conducts peer reviews of other OIGs and maintains 
automated data and management information systems used by all OAS 
employees. The office also provides oversight for audits of state and 
local governments, universities, and nonprofit organizations conducted 
by non-Federal auditors. The office provides education to agency 
employees about prohibitions on retaliation, and the rights and 
remedies against retaliation, for protected disclosures, as required of 
the Whistleblower Protection Ombudsman.

Section QJ.00, Office of Investigations--Mission

    The Office of Investigations (OI) is granted full statutory law 
enforcement authority under the Homeland Security Act of 2003 (Pub. L. 
107-296). OI is responsible for protecting the integrity of the 
programs administered and/or funded by HHS by conducting criminal, 
civil and administrative investigations of fraud and misconduct related 
to HHS programs, operations and employees. The office serves as OIG's 
liaison to the DOJ on all matters relating to investigations of HHS 
programs and personnel, and reports to the Attorney General when there 
are reasonable grounds to believe Federal criminal law has been 
violated. OI serves as a liaison to the CMS, State licensing boards, 
and other outside organizations and entities with regard to exclusion, 
compliance, and enforcement activities.

Section QJ.10, Office of Investigations--Organization

    The office is directed by the Deputy Inspector General for 
Investigations, aided by Assistant Inspectors General, and performs the 
functions designated in the law (section 3(d)(1)B of the Inspector 
General Act) for the position of Assistant Inspector General for 
Investigations. The office is comprised of headquarters and regional 
functions.

Section QJ.20, Office of Investigations--Functions

    OI conducts criminal, civil, and administrative investigations of 
allegations of fraud, waste, abuse, mismanagement, and violations of 
standards of conduct within the jurisdiction of OIG. OI establishes 
investigative priorities, evaluates the progress of investigations, and 
reports findings to the Inspector General. The office develops and 
implements investigative techniques, programs, guidelines, and 
policies; manages OI's quality assurance/peer review program and 
conducts peer reviews of other OIGs. OI also 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. The office effectuates 
mandatory and permissive exclusions from participation in Federal 
health care programs under the Social Security Act; decides on all 
requests for reinstatement

[[Page 13810]]

from, or waiver of, exclusions; and participates in developing 
standards governing the imposition of these exclusion authorities. The 
office also oversees OIG's suspension and debarment referral program. 
OI implements policies and procedures and plans, develops, implements 
and evaluates all levels of training for OI employees. The staff 
provides for the personal protection of the Secretary and other 
Department officials, as needed, and all emergency operations 
preparedness and response. OI coordinates the adoption of advanced 
digital forensic acquisition and examination and information security 
technologies to assist in the investigation, prevention and detection 
of fraud and abuse; maintains an automated data and management 
information system used by all OI employees; provides technical 
expertise on computer applications for investigations; and coordinates 
and approves investigative computer matches with other agencies.
    In addition, the office operates a toll-free hotline to permit 
individuals to report suspected fraud, waste and abuse within HHS 
programs.

    Dated: March 9, 2016.
Daniel R. Levinson,
Inspector General.
[FR Doc. 2016-05714 Filed 3-14-16; 8:45 am]
 BILLING CODE 4152-01-P