The OIG was part of the investigation that included inspectors general from the U. OIG collaborates with other agencies to stop health care fraud. October 14, Determining Who Needs Counsel. Even if contrary to company policy, the action would in all likelihood be attributable to the company, and the company could be held vicariously liable if the individuals involved possessed the requisite knowledge and intent. In such a situation, the interests of the company, the supervisor and the employee may vary.
Accordingly, counsel for the company should refrain from saying anything that may be construed as legal advice to a witness. Where an individual has committed a crime, the corporation has an interest in punishing and disclosing the conduct.
Employees who have committed crimes using the corporate structure, however, cannot expect protection from their corporate employer. Finalizing Findings, Voluntary Disclosure, and Cooperation. Ogrosky pointed out differing obligations that may arise when internal investigations are conducted.
Such reports to state officials may implicate a false claims analysis should the quality of care be so low that DOJ considers program payments excessive. Preparation for Interviews. They have questions for you. What should you do? The Office of Inspector General is the law enforcement division of the U. Department of Health and Human Services. While the HHS OIG is responsible for fighting waste, fraud, and abuse affecting all federal healthcare programs, it primarily focuses its efforts on combatting Medicare and Medicaid fraud.
In order to fight Medicare and Medicaid fraud, the HHS OIG targets healthcare providers and other entities that bill these programs for patient services, medical supplies, and durable medical equipment DME. It targets all types of intentional and unintentional billing violations, as prohibited by the applicable program billing regulations, the False Claims Act, the Anti-Kickback Statute, the Stark Law, and various other sources of federal authority. In any case, once an investigation has been opened, the purpose of the investigation is to determine whether there is enough evidence for federal prosecutors to pursue civil or criminal charges.
If the investigation produces sufficient evidence to establish probable cause to believe that a civil or criminal offense has been committed, then the HHS OIG will either pursue a case directly or work with the U. Department of Justice DOJ to seek an indictment in federal district court. Put our highly experienced team on your side Dr. Nick Oberheiden Founder. Former Senior Trial Attorney U.
Department of Justice. Former U. This is my colleague Jane Doe. Are you Dr. Because the goal of an investigation is to determine the truth or falsity of matters alleged, the procedures used in the investigative process focus on obtaining relevant facts so as to address all aspects of an allegation.
An investigative plan outlines the pertinent facts of an allegation and how to best obtain evidence that will either prove or disprove matters essential to the offense alleged. Investigative activities include examination of documents, such as files, contracts, vouchers, reports, and memoranda.
Investigators also obtain information by interviewing witnesses, technical experts, and the subjects of investigations. Information obtained from such interviews may be documented in records of interviews, by affidavits sworn under oath, and in depositions given under oath, and transcribed by a court reporter. After all relevant information is gathered, an investigative report is prepared.
When there is evidence of criminal wrongdoing, the report or a referral may be presented to the DOJ or other law enforcement entity to consider for prosecution in Federal Court or other appropriate court.
If the evidence presented shows an administrative offense demonstrating fraud, waste, or abuse, the report will be sent to appropriate FCC manager s for action. Documents Section 6 of the Inspector General Act gives the IG authority to obtain the following documents from the agency: all records, reports, audits, reviews, recommendations, and other materials that relate to FCC programs and operations.
This section of the statute also authorizes the IG to issue subpoenas to obtain documents from outside the Federal government. Access to financial records is authorized under the Right to Financial Privacy Act. Individuals Government employees mainly participate in OIG investigations by providing information to investigators and participating in interviews.
The vast majority of employees voluntarily consent to interviews and fully cooperate by supplying information and documents within their control. Employees who do not voluntarily cooperate may be ordered by a supervisor to appear for an interview with an OIG investigator.
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