Responsibilities of the Office of the Inspector General (HHS)

The office of the Inspector General under the Department of Health and Human Services dedicated to improving HHS efficiency by combating abuse, fraud, and waste. The body spends most of its resources on overseeing Medicaid and Medicare programs on behalf of the government (HHS Office of Inspector General, 2019). These programs affect vulnerable citizens of the country, and they include food and drug administration, National Institute of Health, and Disease control and prevention.

OIG ensures that medical coding and billing professionals maintain federal operating guidelines using Compliance Program Guidance Memorandum. The office also provides a template used by coding and billing professionals to avoid fraud and abuse trouble in Medicaid and Medicare programs. Although not dictated by the law for professionals to follow the suggested guidelines by the OIG, failure to comply them implies prosecution and fines. Department of Justice, in conjunction with other healthcare departments, develops the OIG compliance program. Department of Justice, therefore, prosecutes those involved in fraud and abuse for the OIG. The state and federal budget credit a significant amount of budget deposit to the OIG to coordinate health fraud programs with the state and federal law enforcement activities. Another responsibility of the OIG is to publish guidelines to measure the effectiveness of healthcare fraud compliance programs for healthcare organizations. The guidelines help in assessing employees and vendors in healthcare and comply with fraud prevention laws.

Since the OIG regularly amends the fraud compliance guidelines, healthcare organizations take the responsibility of training and informing involved stakeholders on the added policies. They engage the staff for frequent training sessions where educational campaigns evaluate employee understanding of the training sessions. OIG advises healthcare organizations on how to break down complex regulations relating to fraud into simple information understandably by employees and vendors.

Reference

HHS Office of Inspector General, (2019). Combatting the Opioid Epidemic, retrieved from; https://www.oig.hhs.gov/